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: gail.schermerhorn@ocps.net  or call 407-905-5500.

 

For Office Use Only

 

Hours Recorded By: ___________________________ Date Hours Recorded: __________________

 

 

Administrative Verification: __________________________________________________________