Community Service Form Page 2

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Community Service Log
Log Due by the End of School Year
Student ____________________________________________________________________ I.D. # ____________________
School _____________________________________________________________________Date_____________________
Name of Agency____________________________________________________Supervisor_________________________
Date(s) of Service
Hours Served
Activities on this Date
Signature of Contact Person
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Total Hours
_____________________ Student Signature________________________________________
For Office Use:
Counselor/Approval______________________________ Date____________ Date entry completed__________

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