Ryland Heights Elementary

Community Service Record Sheet

This form must be turned in by: October 28, 2016

Student Name: / Grade: / Teacher:

One qualification for the TIGER WORK ETHIC AWARD is community service. Students must find ways to help others in the community. Expectations for community service are as follows:

·  Students in grades K-2 must have 3 hours each term.

·  Student in grades 3-5 must have 5 hours each term.

·  Hours must be earned outside of the school day and have to be documented on this form.

·  A completed reflection explaining what the student learned from the experience must be completed by the student. (Kindergarten/first grade students may dictate to parents and have them write the reflection. One reflection from each grade level will be read by Mrs. Callahan at the Work Ethic Celebration.)

·  Providing service to family members, including grandparents, is not considered community service but rather an essential part of being a caring family member.

Date student volunteered or performed community service / Place student volunteered or type
of community service performed / Amount
of time
student volunteered / Parent or Sponsor Signature
Total Service Hours
Student Reflection
Please explain what you learned from this experience.
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