Community Service Hours
Student Name:
Student ID#:
School Name:
Grade:
❖ Students are required to complete 80 hours of community service.
❖ Please complete all areas of the community service form and have it signed by your site
supervisor.
❖ Please return this completed and signed form back to your high school counselor.
❖ Keep a copy for your records!
Date
What service did you
perform?
Total number of hours
Site Supervisor Signature
765 Broad Street • Newark, New Jersey 07102 • 973-733-7333 • www.nps.k12.nj.us