Eastlake High School Service Worksheet
Students must complete at least 20 hours of volunteer service their sophomore
and junior year at EHS. They are required to turn this form in to their advisor
for each service activity completed.
Guidelines:
o Must receive a signature from someone in charge of the service activity
o Cannot receive compensation or a grade for the service
o Cannot be mandatory service, required by school, county, or state
o Cannot be service for a relative
Student Name: ________________________ Grade: ________ Advisor Name ____________________
Organization/Name: _____________________________________ Telephone: _____________________
Address (e-mail or postal): _______________________________________________________________
Supervisor Name and Title: ___________________________________ Date of service:
___________
Supervisor Signature: ____________________________ Hours Volunteered: ___________________
Student Signature: ______________________Parent/Guardian Signature:______________________
PREPARATION and ACTION:
What did you do? Why? Who did you serve? Where? When?
REFLECTION and DEMONSTRATION:
Describe the significance of the
community service you did. What impact did it have on you personally? On the
person/group for whom you worked? On the community at large?