Agency/Organization Requesting Community Service* ______
Agency/Org Contact Person ______
Daytime Phone Number ______Email/Cell ______
Date of Community Service ______Times ______
Describe the service requested. Please include time of arrival, duration, location, manpower required, tools required (if not furnished), and if meals or refreshments will be provided. **
______Describe the educational merit. ______
Submit request forms to: Email: or
Drop Off: / Mail or Fax:Sycamore Canyon Academy / Sycamore Canyon Academy
Community Service Request / Community Service Request
36895 South Mount Lemmon Road / P.O. Box 33
Oracle, AZ 85623 / Oracle, AZ 85623
Phone:(520) 896-9391 / Fax: (520) 896-9399
* If this is the first time to work with this Agency/Organization please provide information that describes the nature of the Agency/Organization.
** Attach additional sheets/information as needed.
SYCAMORE CANYON ACADEMY USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
S.A. Leader ______Project Needs ______
Staff Leader ______Project Approved ___ Denied ___ Reason______
Project Location & Directions ______
______
Agency Person Contacted ______Date of Contact ______
Staff Printed Name & Signature ______Date ______
Travel Roster Must be Completed? Completed □