Community Service Sign In Sheet
Date:__________
Name: _________________________ Phone :______________
Home Address: ________________________________________
City: _____________________
County of Home Address
(ex: Dallas County) : _______________
Zip Code: __________
City of court: _____________ Charge issued: _____________
(ex. Public Intoxication (PI))
Projects Completed:
______________________________________________________
Age: _____ Gender: _____________
Race/Ethnicity (check one):
African American
Native American/Aleut
E
skimo Asian/Pacific Islander
Caucasian
Hispanic/Latino
Other
Unknown
OFFICE USE ONLY:
Staff Initials:_____ Money Order #:_______
# of Projects Completed: ______ Online Hours E
arned: ________
Hours Volunteered at The Council: ____
______
Type of Work Done:______________________________________
_______________________________________________________
Total of Paid Money Order: $________
Certificate of Completion Given: ___
YES ___NO
Mileage Driven (if in office): ______________
