Community Service Completion Form
[Pages:1]Community Service Completion Form
To be used to receive credit from community service organizations/clubs/teams. Please fill out one form per each organization/club/team that received your community service.
Date: ______________________
Student Name: _______________________________ GRADE: __________ Name of Organization/Agency: _____________________________________ Name of Supervisor: ______________________________________________________ Address of Organization/Agency: ____________________________________________ Phone Number of Organization/Agency: ______________________________________ E-mail of Organization/Agency Contact: _____________________ Brief Description of community service performed: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
Number of Hours performed: ____________________
Signature of Supervisor/Advisor/Coach___________________________________________
For PVHS Use Only: Coordinator Approved; ________
Date: ___________
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