You are on page 1of 1

Group Leader __________

Bloomfield Hills High School


National Honor Society
Service Form

Student Name

_______________________________________________

Name of Service Activity

_______________________________________________

Date(s) of Service

_______________________________________________

Location of Service

_______________________________________________

Total Service Hours

_____________

Brief Description of Service Activity


What did you contribute? What tasks did you perform?

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Supervisor Signature

_________________________________________________

Supervisor Contact
_________________________________________________
Information (phone or email)

You might also like