Community Service Verification Form
This form must be fully completed and turned in to Mrs. Courtois (Career Center) within 30 days from the first date of service
(No Exceptions) to receive credit for your required community service hours.
Please remember: Community Service is more than just “working for free”!!
Twenty-four hours of Community Service is required for graduation.
Name_____________________________ Date______________
Graduation Year___________
Pathway Advisor Name______________________________
What organization or organized event did you volunteer for? ____________________________________________________
Why did you choose this project?
________________________________________________________________________________________
________________________________________________________________________________________
What did you specifically do while volunteering?
________________________________________________________________________________________
________________________________________________________________________________________
Dates and times of community service hours for one specific activity: List below for each date: If you worked multiple dates use
the activity log. If you need to log more than 3 times attach yellow sheet.
DATE:
/ /
TIME YOU WORKED: __________________ _# OF HOURS______________
DATE: _____/__/_________________________TIME YOU WORKED: ____________________# OF HOURS_____________
DATE: _____/__/_________________________TIME YOU WORKED: ____________________# OF HOURS_____________
Describe how the community benefited from the activities that you performed while volunteering:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Student Signature (I have read the back of this form.) ________________________________________________Date ______
Organization Supervisor Signature ______________________ (Phone #) __________ Date ________ Hours Worked______
(Supervisor should not be a parent. Supervisor should record total hours worked…not the parent/student.)
Administrator’s Signature ____________________________________________ Date ____________________
Pre Approval (Mrs. Courtois - if needed) ________ Final Signature (Mrs. Courtois) ____________________Date ____________
Approved______ Denied ______ Late______ Need Signature_____ Other_____
What is Community Service?
YOU CANNOT EARN COMMUNITY SERVICE HOURS JUST BECAUSE YOU AREN’T GETTING PAID!!!
COMMUNITY SERVICE SHOULD BE COMPLETED THROUGH A NON-PROFIT ORGANIZATION
OR IF A FOR-PROFIT ORGANIZATION, IT MUST BE PRE-APPROVED BEFORE BEGINNING!
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Community service is a method by which students learn and develop through active participation in organized activities designed to improve the quality of life of
community members or to help solve particular problems related to their needs.
Community service fosters civic responsibility by providing you with the opportunity to involve yourself in a variety of enriching, useful, and practical experiences
which serve the school and community.
Through community service, you can learn new skills, assume responsibilities, become aware of the needs of others, and learn the importance of unselfish serving
and giving. Community service links you to the wider community and exposes you to people and situations outside your previous experiences.
As a part of the Pathways Program, students are required to complete 24 hours of Pathway approved Community Service during their four years of high school
(outside of school hours).
Freshmen are not eligible to earn Community Service until the first day of school their Freshman year. Sophomores, Juniors and Seniors may do Community
Service during the summer if they choose. Pre-approval is always a good idea if there is any question. If you do not have pre-approval, you always run the risk of
an activity not being approved. Activities listed on the “white board” in the hall are pre-approved and do not require a pre-approval signature.
Citizenship Portfolio
The Citizenship Portfolio, one of the four portfolios for the Pathway Project, allows each student to explore what it means to be a
responsible citizen. The intent is to foster an ethic of service and responsible citizenship through active participation in thoughtfully
organized experiences.
The following information is intended to be helpful to parents in helping their students complete the Community Service aspect of
the Pathway Project.
When choosing a community service experience, ask yourself: “How does the community benefit from my volunteer time?”
The following criteria describe guidelines for community service hours that are accepted at Cashmere High School:
 Must be completed with a recognized non-profit organization and/or an organized event, under the direct supervision of an
authorized adult
 If with a for-profit organization, must be PRE-APPROVED
 Must be completed outside of normal school hours (you many not be excused from school to complete a community service)
 Must be volunteer work only
 Cannot be used for class projects or any activity that will affect your grade
 Cannot be completed for relatives or friends
 Cannot be used for court required community service
 Student must dress appropriately and follow ALL school rules while serving community service
 Must be working with the community (people) and not doing the work of a paid position in the organization/office
 Must be working with an organization, under adult supervision. One on one activities are not permitted.
Examples of acceptable Community Service hours:
 Any community service opportunity advertised on CHS “white board” is pre-approved
 Serving dinner for a non-profit service club or similar organization
 Working at an animal shelter
 Helping at High School Track meets, wrestling meets, and Junior Olympics if you are not on the teams
 Volunteering for a sports organization such as Little Wrestlers (cannot be a fund raiser for your group)
 Through a school club, joining a community service project such as the Walk-A-Thon for the March of Dimes
 Volunteering at any community outreach program, such as Goodwill, United Way, YMCA, Big Brothers/Sisters, Serve Wenatchee
Valley
For Profit Organizations:
 Students will be permitted to serve community service with For-Profit organizations on a case-by-case basis. You must submit
your request before performing community service. Pre-Approval is required for For-Profit organizations!
 Examples of Community Service Activities that require pre-approval: Nursing home/Assisted Living Facility (dependent on type of
work you will perform),
Examples of Unacceptable community service hours:
 Working for your neighbors, such as babysitting, yard work, tutoring your friends brother (unless you are involved with a school)
 Fundraising that benefits school, club, sport activity, organization, or church for personal use, such as fundraising for a band/choir
trip, or a church trip to an amusement park.
 Participation in class projects
 If you do community service during the summer without pre-approval, you run the risk of it being denied.
 All summer community service must be turned in within thirty days after school starts.
Twenty-four hours of Community Service is required for graduation.
(They may be done anytime in grades 9-12.) If you have questions, we encourage you to call Cashmere High School at 782-2914.
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Community Service Steps
Get Pre-Approval from Mrs. Courtois for For-Profit Activities or if you have questions about
any activity.
Pick up Community Service form in Career Center.
Perform Community Service
Get Project Supervisor’s Signature
Fill out Community Service Form, Date and Sign. (Read the back of the form)
Get Administrator’s (principal/vice-principal’s) signature
Turn in form with all signatures to Mrs. Courtois
Mrs. Courtois will route the form to your advisor and advisor will record hours and return it
to you to file in your Pathway Notebook.