Free community service form 07
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Community Service Work
Hours
Verification Form
Congratulations! Serving your community through a work project can be a most rewarding way
to give back to those who have helped you. Amity High School wishes to recognize those
students who participate in a community service program and complete a minimum of 25
service hours per school year.
If you have participated in a service project, please complete the information below and have it
signed
off on who supervised Once it’s complete, please submit this form to the Career
by the person
Center in order
you. for it to be tracked for
recognition.
Date
Name of
Type of Work Completed
Hours
Verifying
of
Organizatio
Worke
Signature(Pri
Servic
n
d
nt Name &
e
Sign)

(Turn over to record additional
hours)

Hours from the back side:
Total Hours Completed:

I certify that I have completed the above listed hours as a community
service initiative.
Print
Name

Signatur
e

Dat
e

Grade
Class of (Year)
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