Lincoln-Way Community High School District 210 Community Service Form printable pdf download

Lincoln-Way Community High School District 210 Community Service Form

Lincoln-Way Community High School District 210

Community Service Form

Student Name: _______________________________

ID #: ________________________________

Name of the Organization where service is to be done:

__________________________________________________________

Name of supervisor: ________________________________

Supervisor’s Phone Number to confirm activity: (___ )_____________

Date(s) of service: _____________________

Briefly describe service to be completed:

Choose one:

Project was already pre-approved by posting in the school.

Project needs to be pre-approved. Pre-approved by: ____________________________ Date: _________

Signature of Assistant Principal of Curriculum

VERIFICATION OF COMPLETED SERVICE

The above student has completed _____ hours of community service at the above site on _____________.

Date(s)

Site/Organization Supervisor’s Signature: _____________________________

Date: ____________

I, the above student, verify that the information on this form is correct and I have completed the hours

documented above. I verify that all the community service requirements have been met for this activity. I

understand that if any information is found to be incorrect, the hours may not be counted towards the

graduation requirement.

Student signature: __________________________________

Date: ________________

I, the parent or legal guardian of the above student, verify that the information on this form is correct. I

understand that if any information is found to be incorrect, the hours may not be counted towards the

graduation requirement.

Parent/Guardian signature: __________________________________

Date: ________________

Parent/Guardian daytime phone number: __________________________________

Student needs to complete reflection on the back of this form

Lincoln-Way Community High School District 210 Community Service Form