Content
COMMUNITY SERVICE PROJECT AND HOURS FORM
Student Information (Please Type or Print)
Name:
Student ID:
School:
Term:
1234
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)