Hazelwood School District
Community Service Form
STUDENTS: Please complete the entire form. Incomplete forms with inaccurate dates, lack of
signatures or dates of service will not be processed.
Name/Address of Organization:
Description of Service:
Date(s) of Service:
Total Hours Completed:
Agency Supervisor Comments:
Agency Supervisor Signature:
Community Service Coordinator:
Examples of acceptable Community Service activities include, but are not limited to:
Volunteering at a non-profit agency, church or hospital (Vacation Bible Schools, mission trips, church
picnics, church school/daycare)
Volunteering at a day care center that is listed as a 501(c)3 organization by the IRS.
Volunteering to manage high school sports teams, and assisting in theater and musical productions.
Creating a student led community service p