Name of organization where you worked:______________________________________ How did you hear about this service opportunity?_______________________________ Date of service_____________ (mm/dd/year)
Number of hours worked:_________
Project leader or representative from the organization: Print name:_____________________________ Email address:_______________________ Signature:_____________________________________ Date:____________ Phone:_______________________________________ Position:_____________________ Organization's website:_______________________
Your complete answers can be typed or handwritten, but must be legible. 1. What type of service did you do, who did you serve and what did you accomplish? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 2. How is this service relevant to what you are learning in your classes? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 3. What are the most difficult and satisfying parts of the service that you performed? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
service learning record sheet - Riverdale School District
Your Grade (check one): 9th. 10th. 11th. 12th. Name of organization where you ... Service Learning Requirements: 9th Grade: 15 hours. 10th Grade: 20 hours.
