Community Service Experience Reporting

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Please remember to complete this form for each community service experience that you are involved with. Fifth grade students have a goal of 15 hours of service, while students in grades 6-10 have a goal of 30 hours of service.

You are encouraged to keep track of your hours yourself as the year progresses. Don't forget to hit submit at the end of the form - you will be e-mailed a copy of what you submitted if you select that option (at the bottom of the page).

Email *

Record my email address with my response

Name *

Date of Service *

DD/MM/YYYY

YYYY

Number of Hours - Whole Numbers or Decimals only please *

(Example: 1.5) Not 1 hour 30 minutes

Where you performed the Community Service: *

Impact of Volunteer Work *

Choose any that apply . . .

Animal Support

Children & Youth

Community Events

Environment

Health and Wellness

Homelessness/Hunger

Senior Citizens

In-School Hours

Other:

Required

Brief description and reflection about the work I performed: *

Contact Person and Phone Number *

Enter the name and contact information of the person you did the work for.

Submit

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