IB Community Service Form
Student Name
Enter your full first and last name
Your answer
Grade Level *
Enter your full first and last name
Date of service
MM
/
DD
/
YYYY
Amount of Time Contributed (Hours) *
Enter time rounded to the closest quarter hour. 30 minutes = .5 hours. One and a half hours = 1.5 hours
Your answer
Location of Community Service/Event *
Where did this experience take place? Organization and City.
Your answer
Brief Description of Your Service/Contribution *
What did you do?
Your answer
Name + Title of Organization Representative/Supervisor *
Full name and title of the person who monitored your service/contribution
Your answer
Email Address of Organization Representative/Supervisor *
Full name and title of the person who monitored your service/contribution
Your answer
Phone Number of Organization Representative/Supervisor
Full name and title of the person who monitored your service/contribution
Your answer
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