Community Service Form

PALM BEACH VIRTUAL SCHOOL

COMMUNITY SERVICE LOG FORM

Name: ___________________________________

Year of Graduation: _______________

Grade: _______

Student #: ________________

Date Submitted:

_______________

Agency Contact

Date

Time in

Time out

Hours Served

Organization and Address

Service Performed

Signature and Phone

Must be a non-profit organization with the exception of nursing homes, hospitals and daycares.

Pet foster care must be pre-approved, no more than 2 hours per day for a maximum of 20 hours.

*Club and team meetings, fundraisers and events are not community service*

Decorating is not community service.

Hours must be turned in the same year they are completed.

Form must be completely filled out with signatures and duty performed.

Student Signature: _______________________________________________

Total Hours Submitted:___________________

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Parent category: Miscellaneous