Service Experience Service Experience

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Service Experience Name__________________________________ Date_______________ Grade_______ Describe your experience (Service cannot be for relative such as parents, grandparent, aunt/uncle, etc.): ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Supervisor or Parent Signature _________________________________________________________ Student Signature ____________________________________________________________________ Time Involved (ex. ½ hour, 1 hour, etc.) ____________________________________________________ (1 hour = 1 point)

Service Experience Name__________________________________ Date_______________ Grade_______ Describe your experience (Service cannot be for a relative such as parents, grandparent, aunt/uncle, etc.): ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Supervisor or Parent Signature _________________________________________________________ Student Signature ____________________________________________________________________ Time Involved (ex. ½ hour, 1 hour, etc.) ____________________________________________________ (1 hour = 1 point)