Community Service Log
This log will be completed for every community service activity a student completes. A completed and signed verification form FOR EACH SERVICE ACTIVITY must be submitted to your guidance counselor at the conclusion of each semester.
Please type your first name.
Please type your last name.
Please type your year of graduation.
Who is your guidance counselor?
Please type the organization's name with which you worked.
Describe the community service activity you performed.
On what day(s)/date(s) did you perform this community service activity?
How many total hours did you spend on this activity?
By clicking yes and submitting this form, I understand that I may be responsible for completing a Service Verification form for this activity. I understand that all community service activities submitted must be unpaid, volunteer work and fulfill the guidelines stipulated for a Service Distinction Diploma. I understand that all hours could be audited and thus require the verification form to be accurate and complete.
If you have questions about whether an activity would count, consult with your school counselor or Dean.
Never submit passwords through Google Forms.
This form was created inside of Uxbridge Public Schools.
Terms of Service