MT. PLEASANT CHAPTER OF NATIONAL HONOR SOCIETY

Community Service Project Report Form

Directions: This is the community service project report form for the Mt. Pleasant Chapter of the National Honor Society. Please complete all sections by our first meeting of the second semester which will be dated. You are welcome to submit it in to Mrs. Cocovich in room 1202 beforehand.

I. Member Information (Please type or print):

Name: _______________________________

Student ID#: __________________________

E-Mail: _________________________________

Phone Number: ___________________________

II. Community Service Project

Name of project: _____________________________________________________________________

(Brief Description):

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

When did you begin? (mm/yyyy)

_____________________________________

Total Hours (to date):

_____________________________________

Hours per week:

_____________________________________

Supervisor’s Signature:

_____________________________________

I affirm that all information in this form is true, complete, and answered to the best of my ability. Any misinterpretation, false statement, or omission of facts shall be grounds for punishment.

Applicant’s signature and date:

Name:______________________________________________ Date: _____________________________