Student Volunteer Hours Form Page 4
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6Enver Creek Secondary – Graduation Transitions (2015) – Community Connections Component (Student Form)
Graduation Transitions – Community Connections Component
30 HOURS
WORK EXPERIENCE AND/OR COMMUNITY SERVICE
___________________________________
GT Coordinator’s stamp (above) confirms completion
Student Name:
Pupil #: __________ TAG: _____
(please print full name)
1. Type of Activity: (please check the applicable box )
In-school course-related activities
Part-time employment
In-school extracurricular activities
Entrepreneurial activities
Community volunteer activities
2. Name of company/organization(e.g. McDonald's):
3. Address/location of activity:
4. My role in this activity (e.g. sales person, coach, etc.):
5. My specific tasks/duties:
6. Record dates and hours worked:
Date
Hours
Date
Hours
Date
Hours
Date
Hours
Op
Option: From (month) ________ (year) ________ to (month) ________ (year) ________
7. Hours Verification: *
To be completed by Supervisor/Sponsor ONLY.
I hereby verify that the above named student has acquired
hours of work experience
and/or community service under my supervision/sponsorship.
Supervisor's/Sponsor's Name: (print full name)
Supervisor's/Sponsor's Signature:
Telephone #:
Date: (month/day/year)
*Attention Student:
If you are unable to obtain a signature you can attach a signed reference letter or a
pay stub indicating hours worked and attach it to the back of this 3 page document.
Submit for marking only when all 30 hours of work experience and/or community
service have been completed.
___
Satisfactory
See GT Coordinator Immediately
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