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Roy & Dora Whitman Academy

Amman, Jordan

Community Service Credits Report

Name: _____________________________________________________ Grade Level/Year of Graduation: ________________________

Name/Description of Service: _________________________________________________________________________________________

Date of Project: _____________________________________ Date of Form Submission: _____________________________________


To be filled out by Supervisor of project:

Supervisor Name: _____________________________________________ Position: ______________________________________________

Email Address (for verification contact): ____________________________________________________________________________

How many hours (approx.) did the student serve? ___________ (without pay)

Supervisor Signature: __________________________________________________________________________________________________

To be filled out by Student:

1. Describe the service you performed and the activities involved.

2. Describe its benefits to those around you.

3. What objectives did you achieve?

4. Describe some things you learned about yourself through this project.

5. Did you enjoy this project? Why or why not?

To be filled out by CS Coordinator:

Signature: __________________________________________________ Number of Hours Approved: _________________________

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