Student Community Service Assignment Form 2018-2019
Tier 2 and 3 Community Service Hour(s) Assigned. Please remember to contact parent and administration about this community service assignment. Students will be reminded every other Friday about hours owed.
*** Make sure you conference with student regarding assigning them community service. Students need to be told you are assigning them community service and why. ***
Student Last Name *
Your answer
Student First Name *
Your answer
Grade Level *
Required
Staff Name (filling out this form) *
Your answer
Choose the behavior(s) that warranted this community service assignment. *
Required
Total Service Hours Assigned *
Please add up the assigned hours from above.
Your answer
Has the student's parent been contacted? (This is a required task. Please compete within 24 hours of assigning service.) *
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