NATIONAL HONOR SOCIETY
CHAPTER SERVICE/INDIVIDUAL SERVICE
Student (please print): ________________________________
Adult Supervisor (print): ______________________________
Phone or email: _________________________________
Type of Service (circle one): Chapter Individual
Date(s): ____/____/____
Hours: ________
Description of Service (please explain your project):
Student Signature: ___________________________________
Adult Supervisor Signature: ___________________________
To be turned in to Mrs. Ruland
Attention: Adult supervisor must not be your parent. Locate an adult who can
verify your involvement. If this is not possible, talk to Mrs. Ruland.