Free community service form 20
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SCITUATE HIGH SCHOOL COMMUNITY SERVICE FORM
Please see the Student Handbook for SHS Community Service Guidelines.
Once you have completed your community service activity, list the dates, times and total hours and have it signed by the supervisor
in charge of the activity. Submit this sheet to your School Counselor.

Student Name:

Year of Graduation:

School Counselor:

School Counselor initials:

Organization Name/Place of Activity:
Type of work performed:

_
_
_
Explain how this activity/service helped the community:

_
_
_
_
_
Record of Hours: (Use the back sheet if needed.)
Dates:

Times:

Total Hours:

_
_
_
Community Service Site Information
Supervisor’s Name:

(cannot be a parent)

Telephone:

Address:

Email:

Supervisor’s Signature:

Date:
For office use only:

Entered into Aspen: