Community Service Record Of Volunteer Service Hours Form
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1COMMUNITY SERVICE PROGRAM
RECORD OF VOLUNTEER SERVICE HOURS
MAXIMUM NUMBER OF HOURS ACCEPTED PER DAY IS 8 (EIGHT)
Student Name:
ID#
Class of:
Intended Purpose of Community Service Hours (check all that apply):
Bright Futures
HS Credit
Graduation Honors
Contact
Person’s
Agency
Activity
Time
Time
Total
Date
Name
Performed
In
Out
Hours
Signature
Total Hours Volunteered:
Agency Name: _______________________________________________________________
Service Supervisor Name: _______________________________________________________
Service Supervisor Signature: ____________________________________________________
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Parent category: Miscellaneous