Community Service Completion Form
To receive credit form community service organizations/clubs/teams, please fill out one form for each organization/club/team that received your community service.
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Student Name
First Name
Last Name
Grade
Name of Organization
Address of Organization
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Number of Organization
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address of Organization
example@example.com
Brief Description of Community Service Performed
Number of Hours Performed
Signature of Supervisor
For Coordinator Use Only
Coordinator Approved?
Yes
No
Other
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: