Community Service Form

Family and Consumer Sciences/FCCLACommunity Service Verification FormNansemond River High SchoolStudent Name: (last) ______________________ (first) __________________ Graduation Year: 20 ______Name of Agency: __________________________________________________________________________Agency Phone Number: (_______) _____________________ Agency Email: ________________________Agency Address: ____________________________________________________________________________________________________________________________________________________________________Name of Site Manager: _____________________________________________________________________Signature of Site Manager: __________________________________________________________________(not your parent)Dates and hours served (include month, day, and year)Date Activity HoursTotal hours served at this agency: ____________Starting date: ____________________________ Ending date: ____________________________Hours must comply with the directions on the reverse side of this page.Directions for completing this form are also listed on the reverse side of this page.Mrs. Windi D. Turner/FACS Teacher and FCCLA Advisor

Family and Consumer Sciences/FCCLACommunity Service Verification FormNansemond River High SchoolDirections for completing this form are below. The form is also available on Mrs. Turner’s blog.1. Please print neatly.2. Use one form per agency and attach a second form if you need more space.3. Please complete the entire form with all of the required information, including month, day,and year of service; your graduating class; and agency signature.To be eligible for recognition of your volunteer time in any given school year, you must:1. Complete those hours of volunteer service and turn in this form to Mrs. Turner by 2 p.m. onMay 1, 2011.2. Record all your hours on these forms and have a supervisor at the agency sign them.3. If there is any question about whether your hours will qualify, that decision should be madeprior to April 1, 2011.The following examples of volunteer projects are eligible:Volunteering at a non-profit organization, without pay.Community organizing including voter registration and political campaigns.Service at NRHS through a teacher, coach, or administrator.Service-learning projects outside of class, including the training and preparation time.Time served with an organization that may also require community service of its members(Boy Scouts, Girl Scouts, etc.). In these cases, you may not “double dip” but can get recognitionfor hours served beyond those required by your project or membership.The following examples are NOT eligible:Hours spent benefiting a for-profit corporation.Service for which there is no supervising adult other than your parent or guardian.Service that was court ordered.Mrs. Windi D. Turner/FACS Teacher and FCCLA Advisor