Community Service Hours Application
This form must be filed out completely in order for you to receive community service credit hours!
Name (PRINT LEGIBLY): ___________________________________________________________
Student Number (Required):_______________________________________________________
Current Class and expected year of graduation (Circle): Senior – 2011 Junior - 2012 Sophomore - 2013 Freshman - 2014
Are you planning on applying for the Florida Bright Futures Scholarship? ____________________
Was this part of a school club function? ______ If so, which club? __________________________
Number of hours (rounded to the nearest hour): __________
Activity Name: ____________________________________________________________________
Describe what you did in detail: _______________________________________________________________
Activity Date(s) including year: ______________________________________________________
Activity or Site Supervisor’s Name (Please Print): _______________________________________
Activity of Site Supervisor’s Signature: ________________________________________________
Phone number of supervisor (for verification of hours): __________________________________
Note: Please be advised that your transcript only allows for 99 hours of volunteer work per school year. If you complete more it will be on file at the school but may not show up on your transcript.
If you have any questions about community service hours, please see the Service Learning Coordinator, Ms. G Schermerhorn (Room 507), send an email to: firstname.lastname@example.org or call 407-905-5500.
For Office Use Only
Hours Recorded By: ___________________________ Date Hours Recorded: __________________
Administrative Verification: __________________________________________________________