Data Entry Date____
Data Entry Initials____
Kamehameha Schools Maui Campus
270 ‘A’apueo Parkway
Pukalani, HI 96768
Community Service Verification Form
(Student fills out this portion)
Name: ______Class of: ______School Year: 20___-20____
Number of Hours spent at activity: ______Activity Date: ______
Name of Agency: ______
Supervisor in charge: ______Phone Contact: ______
Describe duties or responsibilities: ______
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______
Agency Verification (Supervisor of agency fills out)
Duties or responsibilities: ______
______
______
Signature of Person in charge: ______Date: ______
Contact number: ______
Comments: ______
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Do not write below this line.
Verification by counselor or school official
Name of person contacted: ______Phone number: ______
Counselor Approval of Activity:______Date: ______
“The best test, and the most difficult to administer is: Do those served grow as persons; do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants?”
-Robert Greenleaf
Servant Leadership
Service Reflection
(Please answer the following questions before submitting the service form)
1. Why did you choose to do this particular Community Service?
2. How do you think the Community Service you did impacted the community?
3. Do you feel this Community Service project was important?
4. Summarize the most important things you will take with you from the experience?
5. How did participating in this project make you feel?
6. Would you do this Community Service again?