Community Services
Sara M. Gilmore Academy
Community / Volunteer Service
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: ________________________________________________________________
Homeroom Teacher ______________________________ Grade _________ Homeroom # _____
Description of the Community Service: ___________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Summary / Comments of Volunteer: ______________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Amount of Time Spent on Community Service: ___________________ Date: _____________________
Signature of Volunteer: ________________________________________________________________
Signature of Supervisor: ______________________________________________________________
Signature of Homeroom Teacher: _______________________________________________________
Signature of Principal: ________________________________________________________________