NECP JR Beta Club Community Service Form (2016 - 2017)
*Students should complete a minimum of 15 community service hours per semester.
*Students should report hours as they are completed throughout the school year.
*The last day to submit hours for 1st semester of the 2016 - 2017 school year will be Friday, December 16, 2016.
*The last day to submit hours for 2nd semester of the 2016 - 2017 school year will be Friday, May 26, 2017.
*NOTE: Failure to met these community service requirements will result in students being placed on probation from the NECP Jr Beta Club.
Last Name *
Your answer
First Name *
Your answer
Current Grade *
Your answer
Homeroom Teacher *
Your answer
Date of Activity *
MM
/
DD
/
YYYY
Summary of Activity *
Brief description of service performed
Your answer
Hours *
Number of hours of service performed
Your answer
Supervisor's Name *
Your answer
Supervisor's Contact Information *
Phone number or email address where supervisor can be contacted to verify service
Your answer
Submit
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