A+ Program

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					                        A+ Program
                 Gasconade Co. R-I School District

                        Volunteer Service Report
This document is provided as a convenience for community members to report time
students participating in the A+ School Program spend performing activities for the
benefit of the people of Hermann, Mo. and surrounding areas.

*Please print all information

Date: ________________________

Name of Organization or Agency: ____________________________________________

Address: __________________________         Phone #: ____________________________
         __________________________
         __________________________


Student Name: ______________________________            # of hours: _________________

Supervisor: _________________________________          Phone #: ___________________

Brief description of service performed: ________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________


By signing this document, you are assuring the Gasconade Co. R-I School District that
all information included is accurate to the best of your knowledge.


________________________________________               _____________________
Supervisor of Volunteer Service                        Date

_________________________________________               _____________________
A+ Students                                             Date

_________________________________________               _____________________
A+ Coordinator                                          Date