Free community service form 17
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Community Service Work Study Completion Form
Complete section below and return to the Office of Financial Aid no more than two weeks after Community Service work
is complete.
Student Name
Student WPI ID

Year: (ex 2012)

Company Name:
Company Address
Company Address
City, State Zip
Name of Supervisor
Title:

Phone (

Date(s) & Hours
Communtity Service
work was performed

Date

Date

Date

Date

Date

)
Date

Date

Date

Date

Date

Date

Date

Signature of Community Service Supervisor:
By signing this form you are indicating that the student listed above worked the hours listed at your
General description of work that was performed

By signing this form I understand that I will only be paid for a maximum of 15 hours of community service (unless I’m employed in a year long
position designated by the SAO office). Any hours worked in community service beyond the 15 hours will be considered my own personal

volunteer time given to the organization.

I also understand that if the completion