Community Service Hours Submission Form
Community Service Credit Submission
Student ID (Check for accuracy to ensure credit)
Total Number of Hours
The value must be greater than or equal to 0.
Enter date(s) and hours for EACH day. For example: 1/4/20xx 2 hrs; 2/17/20xx 5 hrs. For extended dates, use timesheet provided on web, attach to form and write see attached.
Describe what you did
What did you learn from this experience?
Barker Road Middle School
Calkins Road Middle School
Sutherland High School
Mendon High School
I am in the class of
Student Phone Number
Carrier (Verizon, Sprint, ATT, etc.)If you do not have a mobile phone, please provide your email again.
Parent Signature (10 Hours or less)/Supervisor Signature (Over 10 Hours) NOTE: LEAVE BOX EMPTY AND OBTAIN HANDWRITTEN SIGNATURE HERE ON PRINTED FORM: