Rev. 11/2016
Page 2 of 3
Name: __________________________________________________
Please write the brief essays on the cover sheet and, on this and the following sheet, list and
describe your community service both required community service and voluntary community
service, using additional paper if necessary. Please list your required service, if any, separately.
Please attach a letter/statement from your principal, guidance counselor, class teacher or an
official of a not-for-profit group who is familiar with your community service stating that the
description of your service activities reflects adequately the nature of the service that you have
carried out.
Be sure to include a description of the community service, positions held (if in an organization,
church group, etc.), approximate number of hours per week, month, or year that you have
served. If a “one time” event, describe your role and time spent. List any achievements in your
voluntary service. If you are still volunteering service to an organization, provide the start date
and state that it is ongoing. The number of hours for the activity should be as of the date that
you send in this application.
Example: “Two (2) hours per week teaching church school – 10 hours per year. Ring bell for
Salvation Army two 4 hour slots + 8 hours per year. Reading to a blind man 3 hours per week
(month, year) from January 3
rd
to March 10
th
= 30 hours to date.”
1. Number of hours of required service credit performed: ________
The number of hours included here should include any service hours which you must
perform to meet a graduation requirement required by your school or any religious
organization.
For example, if your school requires 10 hours of community service as a graduation
requirement or if you are a candidate for confirmation and your church requires you to
perform a certain number of hours of community service as part of your preparation for
confirmation, please include these hours of service here.
If you have no required service, please go directly to number 2, below.
Following the general instructions above, please list the service projects you
performed to meet your service requirement(s):
