Community Services

Sara M. Gilmore Academy
Community / Volunteer Service

Name of Student _________________________________    Marking Period ____________________

Homeroom Teacher ______________________________    Grade _________     Homeroom # _____

Description of the Community Service: ___________________________________________________

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Summary / Comments of Volunteer: ______________________________________________________

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Amount of Time Spent on Community Service: ___________________ Date: _____________________

Signature of Volunteer: ________________________________________________________________

Signature of Supervisor: ______________________________________________________________

Signature of Homeroom Teacher: _______________________________________________________

Signature of Principal: ________________________________________________________________