Community Service Hours Log - Bloomsburg University

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Dean of Students Office
Community Service Hours Log
Name:
Student ID#:
Address:
Contact Number:
Service Date
Description of Service
Hours Preformed
Supervisor’s Signature/Phone
Return form to The Dean of Students Office, KUB room 101. For questions or more information about required
service hours please refer to the website at
OFFICE USE ONLY:
OFFICE CHECKLIST:
Scanned and entered into COCO
Received By:_______________
Date Received:_____________
Staff Initials:__________
Date:_____________

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