Community Service Hours Completion Form

Biology 101 Environmental Biology

See syllabus for due date.

Student Name _______________________________________________________________

Name of Organization ________________________________________________________

Description of volunteer activity performed (to be completed by student)

Dates & times of volunteer work:

To receive credit for completion of your community service, I will need either

·         a phone call, or

·         verifiable email, or

·         signature (see below) from your supervisor. 

My initials here ______ means I have received acceptable confirmation from your supervisor.

Signature from Activity Supervisor or Volunteer Coordinator

AFTER the student has completed the service hours at your organization, please complete the following.

This student completed _____ hours of service with our organization.

Signature of activity supervisor ____________________________________ Date ___________

Printed name of activity supervisor_________________________________

Thank you for your cooperation with this Clark College experience.

Student:  Remember to submit a typed summary with this form.