Service Learning Report Form - Madison Academy printable pdf download

Service Learning Report Form - Madison Academy

ERVICE

EARNING

EPORT

Student: ________________________________

Grade: ________

Date Submitted: _________

(Check one)

Service took place at / for:

 Greater Nashville Community

 Location within the US

 Madison Academy Campus

 Local Church

 International Location

Describe the Event:

Date(s) of Service:

Hours/Minutes of Service:

Rate the Activity (in terms of meaning to you): 1

Boring

So-So

Great

Student Signature

– My signature indicates that I

without

did the above service as described

receiving pay.

Please share any ideas or comments that you feel might improve this event or help create other service

opportunities.

_____________________________________________________________________________________

To the supervisor: Thank you for your help in this project. Please read and sign below.

I attest that the above service was:

1. Supervised by me.

2. Voluntary with no payment or grade received.

3. Not done in behalf of the immediate family or relative.

4. Performed in the indicated number of hours and minutes.

Service Supervisor:

________________________________________ Phone #: (____) ___________

Supervisor Signature: ________________________________________

Date: ___________________

not

Please note that the student’s parent may

sign this form.

Service Learning Report Form - Madison Academy