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2022-2023 Service Hour Form
Please complete this form completely. Do not leave any spaces blank. Be sure to include the date this activity was completed and current contact information for your supervisor.
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Email
*
Your email
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Student's Current Grade
*
9
10
11
12
Supervisor's Name
*
Your answer
Supervisor's Phone Number
*
Your answer
Supervisor's Email
*
Your answer
Description of Activity.
The goal of service learning is to engage students in their surrounding community. Please describe what this activity was about, what you did, and why you chose this activity:
Your answer
Number of hours completed during this activity:
*
Your answer
Additional Information (i.e., service completed in a previous school year)
Your answer
A copy of your responses will be emailed to the address you provided.
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