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Community Service Learning Form
Please fill this out anytime you complete community service learning hours and have your supervisor/teacher email Jennifer Bendgen, as well at jenniferbendgen@woodbine.k12.ia.us
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* Indicates required question
Email
*
Your email
First & Last Name
*
Your answer
Name of Program or Community Service
*
Your answer
Describe the Activity
*
Your answer
Supervisor’s Name & Contact Phone #
*
Your answer
Length of Service Hours
*
Your answer
What did I learn from this experience?
*
Your answer
Date of Service Hours
*
MM
/
DD
/
YYYY
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