Community Service Report Form

The Arts And Social Protest COMMUNITY SERVICE/VERIFICATION

Complete this form at the end of your community service.   Type the information or write legibly.

Student Name:   ______________________________________

Site Information:

Name:   _____________________________________________

Address:  ____________________________________________

City: _________________________________

Phone Number:   _________________________________

Name of Supervisor:  _________________________________

Date of Service:  __________________________________

Name of Activity:  _________________________________________

No. of Hours:   _________________________

Verification Signature:  _____________________________________

Write a clear and full description of your personal participation in this community service activity:

  • Provide a summary of your responsibilities, duties, tasks, etc.
  • Reflect on the benefits that you consider the activity was, or may be, to others.    What did you take away from the experience?
  • Identify improvements that could be made.

Student Signature:  _________________________________

Date:  _________________________

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s

%d bloggers like this: