COMMUNITY SERVICE FORM - ESA
COMMUNITY SERVICE FORM
NAME PLACE OF SERVICE ADDRESS CONTACT AND PHONE DATE(S) OF SERVICE
DESCRIPTION OF WHAT YOU DID:
NUMBER OF HOURS
NAME PLACE OF SERVICE ADDRESS CONTACT AND PHONE DATE(S) OF SERVICE
DESCRIPTION OF WHAT YOU DID:
NUMBER OF HOURS
COMMUNITY SERVICE FORM
NAME PLACE OF SERVICE ADDRESS CONTACT AND PHONE DATE(S) OF SERVICE
DESCRIPTION OF WHAT YOU DID:
NUMBER OF HOURS
I witness that the above student has completed the community service described above.
Signature of high school counselor, teacher or other outside agency which verifies participation.
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