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:  or call 407-905-5500.


For Office Use Only


Hours Recorded By: ___________________________ Date Hours Recorded: __________________



Administrative Verification: __________________________________________________________