Volunteer Service Hours Log

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This form is due
Volunteer Service Hours Log
This form is due
by June 3, 2013.
by June 3, 2013.
2012-2013
Student’s Name: __________________________________________________ Grade Level: ___________
By signing below, both student and parent agree that the information presented here is accurate and truthful.
__________________________________________________
________________________________________________
Student’s Signature
Parent’s Signature
Name of Organization: _____________________________________________________
Phone: _______________________
Dates of service: ________________________________________________ Total Hours Completed: ____________________
Specific job or service description: ____________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________
____________________________________________
Supervisor’s Name & Title
Supervisor’s Signature
OFFICE USE ONLY
Date received: ______________
Entered into PowerSchool: ________________

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