Miami Beach Senior High

Miami Beach Senior High

Community Service Reporting Form

for services completed under the supervision of a Miami Beach High faculty member

Directions: Keep copies of all of your community service project submission forms and explanation responses. Complete separate forms for each service you wish to record with Miami-Dade County Public Schools. Students who have a social studies class at Miami Beach Senior High are to submit community service responses to their Social Studies teacher. Students who do not have a Social Studies Course should submit community service recording forms to their counselors.

1) Student Name: ______

2) Student ID #: ______

3) Date(s) when Service was Completed: ______

4) Total Number of Community Service Hours Rendered in Relation to this Project: ______

5) Supervising Faculty Member: ______

6) Supervising Faculty Member's Signature:______Date:______

7) On a separate page, attach a typed or neatly written in ink 3-paragraph reflection on the following:

Explain the service that you rendered to the community. Include in your explanation, a description of the work you did, why the work is necessary, and who will benefit from it.

8) Student's Signature: ______Date: ______

Parents/Guardians, it is a Miami-Dade County Public Schools Policy that a community service project must be completed in order to meet graduation requirements for M-DCPS.

9) Parent or Guardian's Signature: ______Date: ______

______

For Designated Miami Beach High Faculty Member Use Only:

I have reviewed this student's Community Service Project Report

Approve: ______Disapprove:______

Designated School Official’s Signature: ______Date______

Miami Beach Senior High

Community Service Reporting Form

for services completed under the supervision of an organization other than Miami Beach High

For community service performed with organizations outside of Beach High, attach a letter on letterhead and signed by the sponsor, providing your name, explaining services rendered and the number of hours involved in the service.

1) Student Name: ______

2) Student ID #: ______

3) Name of Organization or Institution under Whose Supervision Your Service was Rendered:

______

4) Full Name of Adult who Supervised your Service: ______

5) Supervisor's Phone Number: ______

6) Supervisor's Email, and/or Street Address Associated with Organization: ______

______

7) Date(s) when Service was Completed: ______

8) Total Number of Community Service Hours Rendered in Relation to this Project: ______

9) Supervisor's Signature:______Date: ______

10) On a separate page, attach a typed or neatly written in ink 3 paragraph reflection on the following:

Explain the service that you rendered to the community. Include in your explanation, a description of the work you did, why the work is necessary, and who will benefit from it.

11) Student's Signature: ______Date: ______

12) Parents/Guardians, it is a Miami-Dade County Public Schools Policy that a community service project must be completed in order to meet graduation requirements for M-DCPS.

Parent or Guardian's Signature: ______Date: ______

______

For Designated Miami Beach High Faculty Member Use Only:

I have reviewed this student's Community Service Project Report

Approve: ______Disapprove:______

Designated School Official’s Signature:______Date: ______

Miami Beach Senior High School

Community Service Activity Log

*This form is optional and should be completed in addition to the ‘Community Service Reporting Form’. Use this form to document community service activity to assist in completing the Community Service Reporting Form. It is always a good idea to save a copy of this form for future use. J

Date / Community Service Activity / Project Supervisor’s Name/Signature / Supervisor’s Phone Number / Hours Completed