Community Service Log - Student Conduct University Of Georgia printable pdf download

COMMUNITY SERVICE LOG

Office of Student Conduct

The University of Georgia

Student Information

Agency Information

Name: ______________________________________

Agency: ______________________________________

Address: ____________________________________

Address: ______________________________________

Phone #: ____________________________________

Phone #: ______________________________________

Supervisor: ____________________________________

My community service hours verification will be kept on a separate sheet (please circle one): YES

STUDENT: In accordance with the decision you received, you must complete your community service at an agency listed on

the Office of Student Conduct (OSC) website ( ). If for any reason you wish to use an agency outside

of those listed on the webpage, you must contact the OSC at (706) 542-1131. Hours completed at an agency outside of those

listed on the webpage will not be accepted toward completion of your sanction unless they have been approved by OSC.

SUPERVISOR: On occasion, students involved in the conduct process may also be involved with the court system. As a

result, students may ask site coordinators to sign off on two timesheets (one for the court system and one for the Office of

Student Conduct). We want to assure our community partners that the Office of Student Conduct allows students to count

hours completed at one site for both their court-mandated service hours and their university-mandated community service

hours. Should you have any questions or concerns, please feel free to contact us at (706) 542-1131 or conduct@uga.edu.

You MUST have your community service site supervisor sign the form upon completion of the first half of your

hours and again after the second half of your hours. It is YOUR RESPONSIBILITY to return this log and/or any

additional timesheets to OSC, 247 Memorial Hall, by the stated deadlines. You must also complete group reflection facilitated

by the Center for Leadership and Service after the completion of half of your allotted hours. Failure to comply with the

sanction as outlined on this form may result in additional charges being filed against you.

FIRST HALF OF HOURS:

Hours Required

: ______________________________

DATE

OUT

#HOURS

Due Date: _________________________________

TO BE COMPLETED BY SUPERVISOR:

I, ________________________________, verify that the above student has completed a total of ____________ hours with

this agency.

Supervisor’s Signature: _________________________________________ Date: _____________________________

Community Service Log - Student Conduct University Of Georgia