MENOMONIE HIGH SCHOOL COMMUNITY SERVICE PROGRAM Goal: All Menomonie High School students will contribute service time for the benefit of their community. Students dedicating at least 75 hours of service to the community prior to graduation will receive a special recognition at their graduation ceremony. This achievement would then also be a part of their permanent record Community Service Criteria 1. 2. 3. 4. 5. 6.

The service shall not be performed for a relative. The service shall be performed WITHOUT a material reward. Attending meetings or being on committees will not qualify as service credit. Credit can be granted for fundraising activities for worthy community causes. Entertainment or performance activities that are extensions of a class or co-curricular requirements cannot be considered for service credit; however, community based performances may be considered. Up to 50 hours will be counted for any one volunteer activity.

Directions The following form must be completed and submitted to either Mr. Miller (Room 244) or Mr. Davis (Room 230) 1. 2.

Have your volunteer site supervisor verify the total number of hours of work you performed. Provide thoughtful written responses in the reflection portion of the form.

MENOMONIE HIGH SCHOOL COMMUNITY SERVICE VERIFICATION

Last Name

First Name

Middle Initial

Graduation Year Current Grade In School (Circle): Semester:

1st

9

10

11

12

2nd

Location of Community Service: __________________________________ Verification of Service Completed: _________________________________ (signature of site supervisor)

Description of Service Completed: _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Community Service Log: Date

Time

Time

Hours

Started

Ended

________

________

________

________

________

________

________

________

________

________

________

________

________

________

________

________

________

________

________

________ ________ __

TOTAL HOURS: _______ Reflection: Directions: Please express your complete and detailed thoughts for each of the following reflection questions (use notebook paper if more room is required). 1. How did your project benefit the school and/or community?

2. What will you always remember about your community service experience?

Approval of CS Coordinator: ____________ Date: _______________ (initials)

Community Service Form.pdf

Community Service Log: Date. ______. ______. ______. ______. ______. Time. Started. ______. ______. ______. ______. ______. Time. Ended. ______.

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