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!
Name of Non-Profit
Name of Supervisor
OFFICE USE ONLY
Signature of Counselor: _____________________________________________________
Recorded by: ______________________________________________________________