Early College Academy of Columbus
Community Service Record
Date of What time did What time did Signature to verify
Community Total number of
Service you start you finish that Community
Service hours worked
working? working? Service was completed
Valley Rescue 4 hours
6/10/06 9:00 AM 1:15 PM Sally Jane Smith
Mission 15 min.
Reminder: You must have 50 hours for the entire school year. Your hours will be kept on file. Duplicate this form as needed.
Remember that your hours must be validated, and they must be completed with a verifiable charitable organization. Have the form
signed each day you complete hours by the person supervising you as you perform the community service.