Community Service Form

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Community Service Log Sheet
Student Name: ________________________________ Student # (Focus Account): ___________________ Graduation Year: _____________
School Year: _______ Grade Level: ______
Name
of Organization with which the service is being performed: _________________________________________
Summary of community service activities: ______________________________________________________________________________________________
Supervisor’s name:
Supervisor’s phone #:
____________________________________
( _____ ) _______- _________
Supervisor’s email:
______________________________@_____________________
Please Note:
1.
Submitting this log sheet does not mean the hours indicated will automatically be applied. All volunteer hours are subject to verification.
2.
Service Hours must be performed at a NON-PROFIT organization. If you have any questions regarding this, please see guidance counselor.
3.
Students should make a copy of this form before it is submitted and keep that copy for their records.
Date
Activity or Task Performed
Time In Time
Hours
Supervisor’s Signature
Out
Worked
Total Hours Volunteered

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