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North Central Area High School

National Honor Society


Miss Emily Westphal Adviser

Activity Sheet
In order to receive credit for service hours, this form must be completed and turned in within 10 school days of the activity.
Please neatly print all of the following information except signatures. Forms are available in the office and in the art room.

LAST NAME __________________________________ FIRST NAME ____________________

CIRCLE YOUR PRESENT GRADE LEVEL: SOPHOMORE JUNIOR SENIOR

ACTIVITY TITLE: _____________________________________________________________

BRIEF DESCRIPTION OF TASKS COMPLETED: _______________________________________

__________________________________________________________________________

____________________________________________________________________________

DATES OF ACTIVITY: ___________________________________ TOTAL HOURS: ___________

TIME(S) OF ACTIVITY: _______________________________________________________

ACTIVITY LOCATION: ________________________________________________________

YOUR SIGNATURE: ___________________________________________ DATE: ___________

NAME OF SPONSOR/SUPERVISOR OF ACTIVITY: ______________________________________

PHONE NUMBER OF SPONSOR: ___________________________________________________

SIGNATURE OF SPONSOR: ______________________________________ DATE: ___________

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