Community Service Guidelines And Application Form (Page 2 of 2) in pdf

Community Service Guidelines And Application Form Page 2

SEMINOLE COUNTY PUBLIC SCHOOLS, FLORIDA

SCPS COMMUNITY SERVICE STUDENT VOLUNTEER APPLICATION

Student Name___________________________________________________ Grade_______ Graduation Year_________________

Date of Birth _______________ Phone #_______________________ High School _______________________________________

Mailing Address _____________________________________________________________________________________________

I agree to comply with the SCPS guidelines while completing community service:

Student Signature:________________________________________________________ Date:______________________________

Parent Signature: _________________________________________________________ Date:______________________________

Name of Approved SCPS Community Services Site: __________________________________________________________________

Mailing Address:_______________________________________________________________________________________________

Phone:____________________________

Please describe the duties the student will perform: ___________________________________________________________________

____________________________________________________________________________________________________________

Name of Contact Person agreeing to supervise student: (Please Print): ____________________________________________________

Signature of Contact Person: __________________________________________________ Date: _____________________________

Upon completion of 75 community service hours, you will receive .5 credit.

School Counselor Approval: _____________________________ High School: _________________________ Date: ______________

Circle Award Level Hours completed :

FAS = 100 Hours

FMS = 75 Hours

GSV = 30 Hours

Date Completed:______________________ Counselor Signature: ______________________________________________________

SCPS Form 1489 (Revised 05/21/12) SB

Community Service Guidelines And Application Form Page 2