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Record of Community Service: Townsend Harris High School at Queens College

The document is a record of community service form from Townsend Harris High School for a student named Sumaita Hasan. It details that Sumaita volunteered for 6 hours at the Butterfly Food Program run by Middle Collegiate Church from August 17-17, 2014, helping to prepare and distribute food to the homeless. The contact person from Middle Collegiate Church is asked to sign the form to verify the student's service.

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45 views

Record of Community Service: Townsend Harris High School at Queens College

The document is a record of community service form from Townsend Harris High School for a student named Sumaita Hasan. It details that Sumaita volunteered for 6 hours at the Butterfly Food Program run by Middle Collegiate Church from August 17-17, 2014, helping to prepare and distribute food to the homeless. The contact person from Middle Collegiate Church is asked to sign the form to verify the student's service.

Uploaded by

Whimsical Lopsidedchick Seeking Ernesto
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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New York City Department of Education

Townsend Harris High School at Queens College


Anthony Barbetta, Principal

Record of Community Service


To foster the characteristics of responsible members of society, students are given the opportunity to receive recognition for service
rendered to the school and the community at large during the students' free time. We would appreciate if you would take the time to fill out
this form after the student has served the indicated number of hours of unpaid volunteer service at your organization. Please return this
form to the student, as it will be collected in school.
Thank you for your cooperation and assistance.
Please correct any inaccuracies before signing and returning this form to the student.
Organization: Butterfly Food Program
Contact Person Information: Middle Collegiate Church
Name of Student: SUMAITA HASAN
Dates of Service: Began 08/17/2014

phone: 2124770666

email: [email protected]

(903)
Ended 08/17/2014

Number of Hours per week: _________________

Total # of Hours: 6.0

Description of Service Rendered: I helped prepare and distribute food to the homeless.
Additional Comments and Evaluation:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Signature of Contact Person _________________________________________

Date: __________________

Credit claimed for term: Fall 2014


School Use Only

[ ] Denied: ____________________________________________________________________
_____________________________________________________________________
[ ] Processed: __________________________________________________________________
_____________________________________________________________________
Date: ____________________
form created 8/16/2014

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