Free community service form 39
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Community Service Completion Form
To be used to receive credit from community service
organizations/clubs/teams. Please fill out one form per each
organization/club/team that received your community service.
Date:
Student Name:

GRADE:

Name of Organization/Agency:
Name of Supervisor:
Address of Organization/Agency:
Phone Number of Organization/Agency:
E-mail of Organization/Agency Contact:
Brief Description of community service performed:

Number of Hours performed:
Signature of Supervisor/Advisor/Coach

For PVHS Use Only:

Coordinator Approved;

Date: