Community Service Form 2019-20 - Crosby Scholars Forsyth

[Pages:1]Community Service Form 2019-20

(Winston-Salem/Forsyth County)

Deadlines: Grades 11-12: January 31, 2020 Grades 9-10: March 11, 2020 Grades 6-8: April 8, 2020

Please make a copy or take a picture of this form for your records before you submit it. To fulfill your community service

requirement, you must upload this form to your Crosby Scholars Student Portal, mail, fax, or e-mail it to the Crosby Scholars office, or submit it to your counseling office as soon as you complete your community service project, but no later than the deadline listed above for your grade level. One week after you submit your form, log in to your Crosby Scholars Student Portal to confirm you received credit. Please allow more time if you submitted your form at school. Students, complete all three steps before submitting this form!

Step One: Please print your information neatly, and do not leave any information blank.

Student's name: ______________________________________ School: ______________________________________ Grade: ______ Student ID#: _________________________________________ Email address/Telephone #: ___________________________________ Date volunteered: ____________________________ Total hours: ______________ (2 hours required; 5 hours recommended for high school students)

Step Two: Briefly describe what you did as a volunteer. You may also explain how this activity made a difference in your community.

_________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________

Organization's name with which you volunteered: _______________________________________________________________________

Organization's contact person: _________________________________ Email address/Telephone #: _____________________________

Step Three: Ask an adult who supervised your community service activity to sign below to verify your participation in this activity.

I,___________________________________________________, verify that _____________________________________________, completed the above listed community service hours under my supervision. A form signed by your own parent will not be accepted.

For guidelines and community service opportunities, visit . Community service may not be performed at for-profit organizations or businesses, unless the service benefits a non-profit organization. Crosby Scholars staff reserves the right to determine if this activity fulfills its community service requirement. An adult who supervised this community service activity must sign this form to verify your participation. Make a copy or take a picture of this form for your records before you submit it.

2701 University Parkway, Winston-Salem, NC 27105 336-725-5371 (Phone) 336-725-1321 (FAX) info@

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