COMMUNITY SERVICE



|[pic] |COMMUNITY SERVICE FORM |

Every member of H.H. L. Student Leadership Development must complete 15 hours of volunteer work as part of his/her graduation requirements. Students must:

a) Complete the work for neither money nor credit

b) Have your supervisor verify you completed your hours

Submit this completed form to Old Gym Building, Room 302 on or before __________________

Student Name: _______________________________________________

|DATE HOURS |HOURS |NAME OF AGENCY |TYPE OF WORK PERFORMED |SUPERVISOR’S SIGNATURE |SUPERVISOR’S |

|PERFORMED |WORKED |WHERE | | |PHONE # FOR VERIFICATION |

|(LIST EACH DAY SEPARATELY) |ON THIS DAY |PERFORMED | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| |TOTAL |FOR OFFICE USE ONLY |

| |HOURS |Computer entry |

| | |Total hours entered:____________________ Date entered:___________________ by:________________ |

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