Students: Please use this form to record your community service hours.

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Name:___________________________________ Grade______ School Year _______

Date of Activity _______________________________________

                          Month              Day              Year

Volunteered from ____________ to ________________

                              (Time a.m./p.m.)

Total Hours _________________         NHS Member _________yes      ________no

Description of Activity ___________________________________________________

Agency Rep. or Club Sponsor __________________________

Agency Rep Phone Number    __________________________