Middle School Student Service Hours

Please fill in this form to report your community service hours.
First Name
Last Name
Date must be entered in MM/DD/YYYY format
Date cannot be in the future

Only one date can be entered. If service occurred over time, enter the last date of your service. Put the start and end dates in the description below.
Date of Service
Hours Worked
Use integers and decimal points (e.g., 1.5)
School Name
School Club or Service Organization
Description and Comments (type of activity, location, etc.)
Activity Sponsor Name

By submitting this information you are pledging that all of the information above is true and correct to the best of your knowledge.