Free community service form 19Free community service form 19
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COMMUNITY SERVICE FORM
VOLUNTEER’S PRINTED FIRST NAME

LAST NAME

STUDENT SIGNATURE
GRADE AT TIME OF SERVICE
GRADUATION YEAR

HOURS OF SERVICE

TO BE FILLED OUT BY VOLUNTEER:
WRITE A COMPLETE AND DETAILED DESCRIPTION OF WORK COMPLETED BY YOU—WRITE A PARAGRAPH IF
NEEDED!!

PRINTED NAME OF PERSON IN CHARGE:
TITLE OF PERSON IN CHARGE:
DATE OF ACTIVITY :
SIGNATURE OF PERSON IN CHARGE:
PHONE NUMBER OF PERSON IN CHARGE:

SIGNATURE OF HOMEROOM TEACHER AFTER WORK HAS BEEN COMPLETED:
PRINTED:

SIGNATURE:

DATE ENTERED INTO SYSTEM:

STUDENTS DO NOT WRITE IN THIS AREA

9th

10th

11th

12th

NUMBER OF HOURS AWARDED BY HOMEROOM TEACHER
AND APPLIED IN SYSTEM (MAX OF 3 HOURS)

STMA COMMUNITY SERVICE
STMA High School Community Service Mission Statement:
To encourage and enhance student involvement in the community and develop a desire to help others while
growing as an individual and a productive member of society.
STMA Graduation Requirement
To earn a diploma from St. Michael-Albertville High Schoo