Form from: STARS Academy (CA-22-12)

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STARS Academy 

Community Service Hours Log 

9th Grade- 10 hours 

10th Grade- 10 Hours 

11th Grade- 26 Hours 

12th Grade- 26 hours 

Community Service Description

Please provide a brief description of the volunteer work that you have completed.  

Student Information

Student First Name

Student Last Name

Brief description of what you did

Provide the First and Last name of Supervisor

Phone Number of Supervisor/Organization

Email of Supervisor/Organization

How many hours of Community Service did you complete?

Date of Community Service

Please sign below

signatureYour signature indicates that the student has completed Community Service Hours

Date

Your name

Your email