Community Hours Form - Father Michael Goetz Catholic Secondary School printable pdf download

Father Michael Goetz Catholic Secondary School

Community Hours Form

Students must complete 40 hours of recorded community service as an Ontario Secondary School Graduation requirement.

Before beginning your service, check the school website for information:

Community hours must be done for a charity or a non-profit organization. A list of approved organizations is included on the

school website. Complete your community hours for one of the approved organizations on the list. If you would like to see an

organization added to the list, contact your guidance counsellor; if the organization is added to the list, you are free to complete

your community hours with that organization, but if it is not, you must choose one of the organizations already on the list. The

organization must be approved before you start your hours. Eligibility is determined solely at the discretion of the school.

Student’s Name: ___________________________________________

Student # ___________________

Name of Organization: _____________________________________________________________________

Address of Organization: ___________________________________________________________________

Signature of Parent/Guardian

: _________________________________________________

(if student is under 18)

Location where community hours were done: __________________________________________________

Start Date of Community Hours: __________________ End Date of Community Hours: ________________

Brief description of activity/duties: ___________________________________________________________

This is to certify that ________________________________________ has completed _________ community

First Name

Last Name

Numeral & Word -- e.g. 6 (six)

hours with the above organization.

Name of Service Supervisor: (Print clearly.) ________________________ Position: ____________________

Signature of Supervisor: _____________________________________________________________________

Phone Number: ______________________________ Date: _______________________________________

Place official stamp or seal of the charity/non-profit organization here.

This form will not be processed without the official stamp or seal of the charity/non-profit organization.

Alternatively, you can hand in a letter on official letterhead from the charity/non-profit; the letter must

include all of the information on this form.

To be completed by the guidance counsellor:

This certifies that _________ community hours have been entered into the student’s record/file.

Signature of Guidance Counsellor: _________________________ Date Entered: ______________________

Community Hours Form - Father Michael Goetz Catholic Secondary School