eSchool

Senior Community Service Project

(Student Copy)

Directions: Fill out the following information about your community service experience on both the top and
bottom of this form and turn it in on the due date. If you are going to be splitting your community service hours
between more than one place, you will need to turn in more than one form. Keep this form until the project due
date and include it in your final project. You will receive points for this form so make sure not to lose it.

No Pre-Approvals will not be approved after March 7th.

Pre-approval date:___________Tuesday,

June 14_____________________

Date(s) Community Service Will Be Completed: ____06/15, 06/16_______ # of Hours: ____6___

Student Name__________Sydney Van Dusen_____________________________________
Name of Organization__________________St. Marys Food Bank___________________
Name of Contact Person______Michelle Dinkins_______________________________
Phone Number of Contact Person_________(602)-242-3663______________________
What will you be doing during your community service?_________I will be working on assembly lines, making
sandwiches, filling meal bags, putting spoons in bags and pacjcking up lettuce and tomatoes.__________

Teacher Signature approval will be indicated by points in the grade book.