Twinfield Community Service Documentation Form

Twinfield Union School


Community Service Documentation



Name: ______________________________                         Date: ______________


Graduating Class year: ________________                  Hours: _____________


Description of Service



Community Service Rules and Requirements

1. Community service must positively impact the community, the school, the environment or a group of people.

2. The community service must be done outside of the immediate family (no babysitting younger brother, etc.).

3. Community service must be entirely volunteer. No pay, in the form of money or credit towards                graduation, can be given.


Was the service completed without pay? YES ___ NO ____

Was the student service acceptable to you? YES___ NO____

Please feel free to comment below on this student’s performance


Please contact Debra Stoleroff (426-3213 x202) if you would like to talk about this student’s service. Please also be in touch if you have opportunities for other students to be of service. We will gladly post and/or announce community service opportunities to our students


Supervisor Name (Please Print):                                                      Title: _________________                                                                 

Organization/Agency: ______________________________  Phone #: _______________                                                                                                                                                                

Street Address: ___________________________________________________________                                                                                                                                                                                     

City ___________________________________  State _______  Zip ________________           


I acknowledge that to the best of my knowledge the above information is correct.


Supervisor Signature:  ________________________________  Date: _______________


Students:  Return this form, completed, to Debra Stoleroff.  A copy will be kept in your service file.  This form must be submitted to recognize these service hours as part of the community service requirement for diploma plus.


Received: ___________________                                 Previous Hours: ______

Recorded: ___________________                                       New Hours: _______

                  Total Hours: _______