Document Sample
					St. Albans Home | Social Sevice | Contract

                                    CONTRACT OF SERVICE
                                St. Albans Social Service Program
                              Mount St. Alban, Washington, DC 20016
                                         Phone: 537-5795
(Please fill out this form, obtain the necessary signatures and submit it to Mrs. Leithauser
before the work begins.)
I have made the following commitment to Social Service under the terms and conditions
specified below and recognize my responsibility to notify my job supervisor and the Social
Service Director at St. Albans if for any reason I cannot fulfill these obligations, if I desire
transfer to another service job, or when I wish to terminate my service work.

    1. Student’s Name (print)________________________________Date____/____/____
    2. Name of Agency or Project_______________________________________________
    3. Location where service will be performed ___________________________________
    4. Name and address and telephone of person signing below who will supervise your
        project and fill out Evaluation forms: _______________________________________
                                                      Name                   Title

                                           Address                           Phone

    5. If you will be participating in any in-service training program that is required or
       recommended?            Yes No
    6. If yes, give dates and times and location of training program ____________________
    7. Anticipated hours, days and months of on the job service work. _________________
    8. Description of job/duties/etc ______________________________________________
    9. Are there any other terms and conditions of work that should be _________________
    10. Projected Starting Date __________________________________________________

    Although sixty hours of social service is required for graduation, we on the Social
    Service Committee believe that not only following the letter but the spirit of the
    requirement is essential. In order to have a valuable service learning experience, an
    appropriate level of care and concern from those who serve is expected. A negative
    evaluation may result in some action of resolve.

                    Signature of Student
St. Albans School                               Contract of Service             Social Service

    I have reviewed this Contract with the Student, agree to provide supervision for his
    training and work and to fill out and return the evaluation form (or its equivalent)
    following completion of the assignment or at the end of each school semester as
    requested by the Student. I understand that the School is to be notified of any accident
    or problems involving the Student while working on this project.

                      Signature of Supervisor

    My son _________________________________________ has my permission to
    undertake the Social Service Project indicated above and I understand that he is
    responsible for his own transportation to and from this service assignment.

                      Signature of Parent/ Guardian