Community Service Form printable pdf download

Community Service Form

Palm Beach Central High School

Community Service Form

20 hours are required for Graduation

(

Print ALL Information Clearly)

Student Name: _____________________________ Student #:__________________ Grade: _____

 Community service hours MUST be completed at a NON-PROFIT ORGANIZATION.

 Community service hours WILL NOT be given for services performed for a parent, relative

or family business.

 You MUST have the supervisor of the organization you volunteered for verify the hours

with a signature and phone number.

 IF EXCEEDING 30 HOURS OF SERVICE WITH THE SAME NON PROFIT ORGANIZATION, YOU

MUST PROVIDE A LETTER OR CERTIFICATE WITH THIS FORM!

Date

Hours

Name of Non-Profit

Name of Supervisor

Contact Number

Signature of

Service

Organization

Supervisor

TOTAL

HOURS

_________________________________________________________________________________________________________________

OFFICE USE ONLY

Signature of Counselor: _____________________________________________________

Recorded by: ______________________________________________________________

Community Service Form