COMMUNITY SERVICE TIME CARD


 				STUDENT (PRINT LEGIBLY):  ________________________________________
			
				AGENCY: __________________________________________________________

				JOB PERFORMED: ___________________________________________________

				
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						(section below to be filled out by supervisor )

				SERVICE DATE: _____ / _____ / _____   HOURS: _____________________

				SUPERVISOR'S SIGNATURE: __________________________________________

				SUPERVISOR'S PHONE: ______________________________________________

				THANK YOU FOR YOUR SERVICE WORK.  WE HOPE IT WAS REWARDING


				SUPERVISOR COMMENTS:

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