Community Service Form
Chimacum High School
Certificate of Community Service
Name |
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YR OF Grad |
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The above student has provided Community Service with:
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Name of Agency |
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SupervisorSignature |
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Telephone #
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Date/s ofService |
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Number/s of Hours
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All community service must be completed in hour increments. Community service work cannot take place during the regular school day.
Students may not receive pay or academic credit for community service. Court-ordered or disciplinary service may not count for community
service.
By signing below, I hereby give approval for my child to participate in this volunteer service to the community.
Parent/Guardian |
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Date |
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WHEN THIS FORM IS COMPLETED, IT IS THE STUDENT’S RESPONSIBILITY TO RETURN
IT TO THE GUIDANCE OFFICE, THE REGISTRAR, OR PORTFOLIO PRODUCTIONS CLASS.
* * * * * * * * * *
Student Participant
Please answer the following questions. This information provides assessment of the Community Service Program.
1. The name of the organization I assisted is:
2. This experience seemed: __ Beneficial to me __ Not Beneficial __ No Opinion
3. I knew what was expected of me on the job __ YES __ NO
4. My supervisor(s) was/were helpful to me __ YES __ NO
5. As a result of this experience I would be willing to contribute more time to community service.
__ YES __ NO __ UNSURE
6. In one or two statements, please indicate what you learned about yourself or the community as a result of this experience.
