Community Service Hours Verification - San Dimas High School
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1Community Service Hours Verification
This form is to be filled out by the student for each separate community service job and signed off by the
supervisor for each separate job. Any forgery or misrepresentation of data is grounds for failure of the
SDCP.
Student
Graduation Year
Date
Time
Hours
Tasks
Mentor
Worked
Worked
Worked
Completed
Initials
TOTAL HOURS: _________
I certify that this log is accurate.
Supervisor Signature:
Supervisor Name (print):
Organization:
Date:
Phone/Email:
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