Western School District

Project LEAPS

(Learning for Everyone—Action for Partnerships and Service)

Community Service Record Sheet (Grades 3-5)

10-14 hours = certificate

15 + hours = certificate and frog

All forms must be handed in by the last Friday in April.

Service must be done in the community.  Helping out a family member does not qualify.

Student: _______________________________________

School: _______________________________________ Grade: ______________

Location of service: _________________________________________________

Date(s) of service: _______________________________       Total hours: ___________

What service did you provide?

How did your service make you feel?

How did your service change or help others?

Student signature: _________________________________         Date: ______________

Adult signature verifying information: __________________________ Date: _________