Community & Service Hours Log

Name: ___________________________________________ Grade:_____ Math Teacher: ____________

My Community and Service activity was: ____________________________________________________
My job was: __________________________________________________________________________
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The best part was:______________________________________________________________________
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The hard part was:______________________________________________________________________
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I made an impact on the people I helped in this way:
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I'm changed because:
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Date(s) of Activity:
Date: _____ Hours: _____

Date: _____ Hours: _____

Date: _____ Hours: _____

Date: _____ Hours: _____

Date: _____ Hours: _____

Date: _____ Hours: _____

Total Hours: _____

Service Organization (if applicable):

Supervisor's Signature:

_______________________________________

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Supervisors Name (Please Print):

Comments:

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Supervisors Phone #:

Students Signature:

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Supervisors Email or Web Address:

Piedmont Math Teacher Approval:

_______________________________________

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