RESEDA SCIENCE MAGNET
COMMUNITY SERVICE FORM
The Magnet’s requirement for forty hours of community service may be served at any time
during the calendar year including summer vacation.
Students are encouraged to choose a form of community service that interests them and affords
an opportunity to learn and enjoy as well as help others. Check with Ms. Coleman to be sure that
the activity you choose fulfills the requirement.
Once you have chosen the activity, complete the form below and have it signed by your
supervisor.
SENIORS – ALL COMMUNITY SERVICE MUST BE TURNED INTO THE OFFICE
BY APRIL 1ST.
--------------------------------------------------------------------------------------------------------------Name: _______________________________________
Grade: _________
Name of Organization:
Address of Organization: _______________________________________________________
Organization Telephone: ____________________________
Nature of Service you performed: __________________________________________________
Dates, Times of Service
______________________________________________________________________________
Total Number of Hours _________________
Supervisor’s Name________________________________
Title _______________________
Phone (where supervisor may be reached) _______________________________
Comments
______________________________________________________________________________
Student’s Signature ______________________ Supervisor’s Signature ____________________
Date __________________
Date ___________________