SERVICE HOUR TALLY SHEET

NAME:__________________________________ DATE:________________________

Please complete the following form after each activity you do that qualifies for service hours. You must fill it in completely and hand it in by the end of the month the activity(s) was in. Any forms not received by the 5th of the following month will not be counted. You must have the sponsoring teacher sign the form to receive credit for the hours. Hand the form into the slot on the wall in the main office. Any questions please see Mrs. Jakobsen.

Activity

Date

No. of Hours

Teacher Name

Teacher Signature

 

        

 

        

 

        

 

        

 

        

 

        

 

        

 

        

 

        
Total hours for the month     If you need additional room fill out another form and staple it to this one.  

Note: To qualify as service hours, the activity you work on must take place at Dover Bay or benefit Dover Bay in some way. The time you put in does not qualify if you receive payment or course credit (e.g. community hours for PE, work experience) for those hours or if you personally benefit (e.g. fund raising for trips to reduce your personal cost). See Mrs. Jakobsen or your sponsor teacher if you are not sure if your hours qualify as service hours.