Community Service: Mrs. Bettencourt Required: 12 Hours/semester

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Community Service

Mrs. Bettencourt
Required: 12 Hours/semester

Student Information: (to be filled out by student)


Name of Student: ____________________________________
period in economics/government: _____

Location where community service was performed: (name and address)


______________________________________________________________________________
______________________________________________________________________________

# of hours of community service performed: ________

Student responsibilities during community service:


______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Student evaluation of experience:


______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Site information (to be filled out by person supervising student work)

Name of organization, school or agency:


___________________________________________________
Contact person: (please print)
___________________________________________________________
Contact phone number or e-mail:
________________________________________________________
Number of hours of community service performed: _________
Evaluation of student performance:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

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