Community Service Verification Form
2017-18
This form must be fully completed and turned in to Mrs. Courtois (Career Center) within 30 days from the first date of service.
24 hours of community service are required for graduation.
Name______Date______Graduation Year______
High School Advisor’s Name______
What organization or organized event did you volunteer for? ______
What did you do while volunteering and how did it help the organization you volunteered for. Please
be specific and detailed ______
______
Dates and times of community service hours for one specific activity: If you worked multiple dates use the activity log
Date Time you worked Hours Date Time you worked Hours
______
Date Time you worked Hours Date Time you worked Hours
______
TOTAL HOURS WORKED (FILLED IN BY SUPERVISOR) ______
Student Signature ______Date______
Organization Supervisor Signature ______Phone # ______Date ______
Administrator’s Signature ______Date ______
Final Signature (Mrs. Courtois) ______Date ______
Pre-Approved____Approved___ Denied_____
*Please read criteria on back for approved community service-ask if not sure
COMMUNITY SERVICE CRITERA FOR CASHMERE HIGH SCHOOL
The following criteria describe guidelines for community service hours that are accepted at Cashmere High School.
Ø Must be completed with a non-profit organization or an organized event, under the direct supervision of an adult.
Ø Must be completed outside of normal school hours (you may not be excused from school to complete a community service)
Ø Must be volunteer work only
Ø Cannot be used for class projects or any activity that will affect your grade
Ø Cannot be completed for relatives or friends
Ø Cannot be used for court required community service
Ø Student must dress appropriately and follow ALL school rules while serving community service
Ø Must be working with the community (people) and not doing the work of a paid position in the organization/office
Ø Must be working with an organization, under adult supervision. One on one activities are not permitted.
Examples of acceptable Community Service hours:
Ø Any community service opportunity advertised on CHS “white board” is pre-approved
Ø Serving dinner for a non-profit service club or similar organization
Ø Working at an animal shelter
Ø Helping at high school track meets, wrestling meets, and Junior Olympics if you are not on the teams
Ø Volunteering for a sports organization such as Little Wrestlers (cannot be a fund raiser for your group)
Ø Through a school club, joining a community service project such as the Walk-A-Thon for the March of Dimes
Ø Volunteering at any community outreach program, such as Goodwill, United Way, YMCA, For Profit Organizations:
Ø Students will be permitted to serve community service with For-Profit organizations on a case-by-case basis. You must submit your request before performing community service. Pre-Approval is required for For-Profit organizations!
Ø Examples of Community Service Activities that require pre-approval: Nursing home/Assisted Living Facility (dependent on type of work you will perform).
Examples of Unacceptable community service hours:
Ø Working for your neighbors, such as babysitting, yard work, tutoring your friends brother (unless you are involved with a school)
Ø Fundraising that benefits school, club, sport activity, organization, or church for personal use, such as fundraising for a band/choir trip, or a church trip to an amusement park.
Ø Participation in class projects
Ø If you do community service during the summer without pre-approval, you run the risk of it being denied.
Ø All summer community service must be turned in within thirty days after school starts. Incoming freshman do not get community service for the summer before their freshman year.
Community Service Steps
1. Get Pre-Approval from Mrs. Courtois for For-Profit Activities or if you have questions about any activity.
2. Pick up Community Service form in Career Center.
3. Fill out Community Service Form, Date and Sign. (Read the back of the form)
4. Perform Community Service
5. Get Project Supervisor’s Signature
6. Get Administrator’s signature
7. Turn in form with signatures to Mrs. Courtois
8. Mrs. Courtois will route the form to your advisor and advisor will record hours and return it to you to file in your Pathway Notebook.