NATIONAL HONOR SOCIETY COMMUNITY SERVICE VOLUNTEER FORM Massabesic High School 88 West Road Waterboro, ME 04087 STUDENT NAME: YEAR AT MHS: YEARS IN NHS: SCHOOL YEAR:

___________________________________________________ Circle one: JUNIOR Circle one:

FIRST

SENIOR

SECOND

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VOLUNTEER ACTIVITY - Where and what and for whom? __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ TOTAL TIME OF VOLUNTEER ACTIVITY - Number of hours: ____________________ DATE COMPLETED: __________________________________________________ SIGNATURE OF ADULT SUPERVISOR: __________________________________________________________________ PRINTED NAME OF SUPERVISOR AND PHONE NUMBER: __________________________________________________________________