Service Hours Log Sheet - Fca Community - 2016-2017
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1FCA COMMUNITY SERVICE HOURS LOG SHEET 2016-2017
NAME __________________________________________________________________________________________________ GRADE _______________________________
STUDENTS: Please write legibly. You are responsible for completely filling in each section and column of this form by following the directions and examples given below.
Incomplete forms will not be accepted. This includes the bottom portion of this form.
DATE of
TASK PERFORMED &
HOURS WORKED
COMMUNITY, SCHOOL, AGENCY,
NAME & TITLE of SUPERVISOR;
SERVICE
BRIEF EXPLANATION
or ORGANIZATION
PHONE NUMBER; & SIGNATURE of SUPERVISOR
List task performed & explain. Example:
List dates
List specific hours worked &
List name of organization you worked for &where they
List name & title of adult supervisor, their phone number, &
Landscaping. Helped with grounds clean-up;
separately.
total. Example: 8:00 – 10:00;
are located. Example:
have supervisor sign form. Example: Mr. John Doe;
gardening. Painting.
Ex. - 7/23/16
2:00 - 3:30 = 3.5 hrs. total
Habitat for Humanity, Gainesville, FL
Facilities Director; (386) 454-1641;
Mr. John Doe
Forms are due at the end of each semester; however, you may turn in any completed forms at any time during the school year. Include the total number of hours worked.
Number of On Campus Hours: ________
+
Number of Off Campus Hours: ________ =
Total: ____________
I verify that this log is a true and accurate record of my unpaid volunteer community service. Student Signature:____________________________________________________
Date Submitted: ________________________ (Circle one: 1
Semester; 2
Semester)
st
nd
5/28/16
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