Community Service Form

MIAMI PALMETTO SENIOR HIGH SCHOOL

COMMUNITY SERVICE PROJECT FORMS
Student's Last Name
Student's First Name
Middle Initial
Student ID Number
Home Address
Apartment # (If Applicable)
City
Zip Code
Grade Level
Home Phone

Area CodePhone Number
Student's Cell Phone

Area CodePhone Number
Student's Email Address
example@example.com
Parent's Name

First NameLast Name
Parent's Email Address
example@example.com
Parent's Cell Phone

Area CodePhone Number
Title of your Project
Grade Level when Project was completed
Required Essay Section:
- Summarize your community service experience in essay form (a minimum of 250 words). Address each of the following in your essay:
  Briefly describe your project and the main activities of your project. Briefly outline the steps you took to plan, implement and complete the project and complete the project. Indicate how much time you spent in completing all aspects of this project.
- Describe the problems that occurred during the project. Explain how these problems were handled.
- Describe the impact you believe your project had on the community or on the people who received your service.
- Describe what you learned about the community as you worked on your project.
- Describe what you learned about yourself and the importance of giving something back to others.
ESSAY (You can type all your text in Word and copy and paste it in this area)

Type a question

Rows	Date	Community Service Activities	Hours Completed
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
13th
14th
15th
16th
17th
18th
19th
20th

Total Project Hours
I have reviewed my son/daughter’s activity log form and understand that a community service project must be completed in order to meet the graduation requirements for Miami Dade County Public Schools. My signature below indicates completion of listed hours of service and project.
SFName
SLName
PName

First NameLast Name
Parent Signature
Student Signature
Counselor 1
example@example.com
Counselor 2
example@example.com
Counselor 3
example@example.com
Counselor 4
example@example.com
Counselor 5
example@example.com
Email To
example@example.com
Should be Empty: