Community Service Pre-Approval Form
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Community Service Hour Guidelines
Before completing this pre-approval form, please ensure that your community service experience adheres to the following guidelines:
 ◾ Students cannot get paid.
 ◾ Internships do not qualify as community service.
 ◾ May not be performed for family members or for profit-making organizations.
 ◾ Must be completed at a NON-PROFIT organization. Hair salons, doctors’ offices, physical therapy facilities, and most daycare centers are FOR PROFIT businesses and are unacceptable.
 ◾ Service performed with a club outside of school hours is acceptable.
 ◾ Service for must be completed before/after school or during free periods (cannot be completed during regular school hours, unless you are involved in the Option Service Learning class).


DIRECTIONS
This Pre-Approval form needs to be completed by students at least 48 hours prior to the service activity in order to give the counselors adequate time to approve. Once the form has been submitted by the student, the student and parent will receive an approval confirmation email from the school counselor. Please be sure to save the confirmation email that you receive from your counselor, because you will need to include a copy of it along your service hours sheet for final approval.  

Student Name: *
Student Email: *
Current Grade: *
Parent / Guardian Name: *
Parent / Guardian Email: *
Date of activity:
MM
/
DD
/
YYYY
Proposed Service Activity: Please give a brief description of the activity you are proposing. *
Community Service Project Location (name of organization/agency): *
Service Hour Supervisor phone number: *
Service Hour Supervisor email address: *
A copy of your responses will be emailed to the address you provided.
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