Community Service Log - Student Conduct University Of Georgia Page 2
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2CLS VERIFICATION:
Complete the form available at
to schedule your group reflection. Students
must make accommodations for attending community service group reflection. Exceptions will only be made for students
with academic and work conflicts. To verify participation in the group reflection, the facilitator from the Center for
Leadership and Service MUST sign the form.
Due Date: _________________________________
Note: This is not an assigned time for your reflection. This is the date by which you must complete a group reflection, receive a signature below, and turn this sheet
into the Office of Student Conduct.
I, ________________________________, verify that the above student has completed the group reflection with the Center
for Leadership and Service as a part of their community service sanctioning for the Office of Student Conduct.
Facilitator’s Signature: _________________________________________ Date: _____________________________
SECOND HALF OF HOURS:
DATE
IN
OUT
#HOURS
Hours Required: ____________________________
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: _____________________________
TO BE COMPLETED BY STUDENT:
I, ________________________________, confirm that I have completed a total of ____________ hours and that I have
participated in a group reflection with the Center for Leadership and Service. I understand that providing false information on
this form may result in additional charges being filed against me.
Student’s Signature: _________________________________________ Date: _____________________________
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