Community Service Log Template
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1COMMUNITY SERVICE LOG
STUDENT I.D.#
STUDENT NAME:
School Year:
Grade:
Adviser:
Instructions:
1. Combine work for the same organization into one entry.
2. Entry must include service month/day/year, and supervisor name/signature and contact info. In lieu of
a signature you may attach verification of service on organization letterhead.
3. Log must be complete and include your signature and date. Incomplete logs will be returned to you.
4. Return completed logs to the Community Service file bin in the Guidance Dept. Service should be reported
within 6 months from date of service. Service older than 12 months will be reviewed and may be deemed
inadmissible.
5. You must complete the reflection for the hours to be recorded and qualify for Bright Futures Scholarship.
6. Do not include hours for Student Assistant/Intern (Semester) - they are automatically input for you.
Total #
Name of Organization
of
(If it is TPS related please write
Dates of
Hours
Supervisor’s Contact
name of club, activity, or event)
Service
Worked
Supervisor’s Signature
phone/email
Reflection: (Please describe what services you performed and what you learned from this experience)
Total #
Name of Organization
of
(If it is TPS related please write
Dates of
Hours
Supervisor’s Contact
Service
Worked
Supervisor’s Signature
phone/email
name of club, activity, or event)
Reflection: (Please describe what services you performed and what you learned from this experience)
HONOR CODE STATEMENT: I will maintain my self-respect. I will not lie, cheat, or steal, nor tolerate anyone who does.
STUDENT SIGNATURE:
DATE:
FOR OFFICE USE:
Date Entered:____________________By:________________________________
Rev 9/16
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