Community Service Form - Woods Charter School

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Woods Charter School
A Public School of Choice
160 Woodland Grove Lane
Chapel Hill, NC 27516
Tel. (919) 960-8353
Fax. (919) 960-0133
C
S
F
OMMUNITY
ERVICE
ORM
Woods requires high school students to complete 50 hours of community service to graduate. Generally, this service
must be:
an action by the student that benefits the community,
outside of school hours,
voluntary (i.e., unpaid, not court-mandated),
supervised by an adult,
in support of a nonprofit, 501 C 3 organization.
If you have an idea of some community service that you want to do, you should check with Mr. Etherington to
verify that it counts for your community service hours. You can view a tally of your approved service hours on
PowerSchool.
Student Name:_________________________________ Grade: _________
Detailed description of service(s) you provided:
s
Date(s)
# of Hours
Date(s)
# of Hours
_____________
_________
_____________
_________
Total # hours
on this form:
_____________
_________
_____________
_________
________
_____________
_________
_____________
_________
Use a separate form for each different community service activity.
Name & Signature of Supervising Adult:
__________________________________ __________________________________ ______
Name
Signature
Date
*** Return completed forms to Mr. Etherington’s Office ***
Updated 12/6/2013

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