DCSD Community Service Documentation
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DCSD Community Service Documentation
Purpose: Through community service students are given opportunities to become responsible citizens by helping others while learning selflessness and fostering personal growth.
Student Information Student Name:
Select School
Student ID#
Graduating Year: Select year Gender:
Organization Information
Organization:
Address:
State:
Zip:
Description
of Service Performed:
Verifying Information
Date of Service Hours Served
Comments:
Dept: City:
Evaluation of Student's Work Unsatisfactory Satisfactory Excellent
______________________________ Verified by Site Contact (please print)
_________________________________ Signature of Verifier
Telephone Number: (If contacted, this individual can verify student's hours)
Student/Parent
I verify that I have completed the above documented service and have followed all guidelines. I understand that I must fully complete all parts of the form including the reflection page in order to have my completed service hours processed to fulfill my community service graduation requirement of 20 hours.
________________________________ _____________________
Student Signature
Date
By signing below, I verify that I have given approval for my child to participate in this service activity, and that he/she has completed the hours of service as indicated above.
________________________________ _____________________
Parent Signature
Date
................
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