Western School District

Project LEAPS

 (Learning for Everyone—Action for Partnerships and Service)

Community Service Record Sheet (K-Grade 2)

5-9 hours = certificate

10 + hours = certificate & 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 of service: _____________

Draw a picture about your service activity.  Students in grades 1 and 2 should also write a short description.

________________________________________________________________________________________________

________________________________________________

How did helping make you feel? _____________________

Student signature: __________________________________ Date: ___________

Adult signature verifying information: __________________________ Date: _________