Free community service form 38
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COMMUNITY SERVICE PROJECT AND HOURS FORM
Student Information (Please Type or Print)
Name:

Student ID:

School:

Term:

 1234

Student Agreement
I understand that ALL community service hours must be completed through a 501(c)(3) non-profit organization or a
federal, state or local government agency.

Name of Student (Please Print)

Signature (Required)

Organization Information
Name of Organization/Government Agency:
Address:
Supervisor Name:

Telephone Number:

Organization’s Tax ID #

Email:

Brief Description of Activity

Date

Time In

Time Out

# of hours

ALL community service hours must be completed through a 501(c)(3) non-profit organization or a federal, state or local
government agency.
Total # of hours:
I certify that these hours have been completed according to the requirements for DCPS Community Service Hours.

Name of Supervisor

Title

Signature (Required)