"Community Service Completion Form - University of Arkansas"

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OSSC- Community Service Completion Form
Student full name _________________________________
Student ID _______________________________________
Student Email ____________________________________
Email form to
judicial@uark.edu
or
Return to Pomfret Hall B110 (Entrance at the circle drive facing Clinton Ave)
Attention: Student Conduct
Contact number for questions: 479.575.5170
Total Hours _________________
________________________________
_______________________________
___________________
_______________
Description of Activity
Organization/Location of Service
Date/Time of Service
Hours Competed
___________________________
__________________________
_______________________
_______________________________
Printed Name and Signature of Supervisor
Phone Number
Email Address
__________________________________
_______________________________
___________________
_______________
Description of Activity
Organization/Location of Service
Date/Time of Service
Hours Competed
___________________________
__________________________
_______________________
_______________________________
Printed Name and Signature of Supervisor
Phone Number
Email Address
_________________________________
_______________________________
___________________
_______________
Description of Activity
Organization/Location of Service
Date/Time of Service
Hours Competed
___________________________
__________________________
_______________________
_______________________________
Printed Name and Signature of Supervisor
Phone Number
Email Address
________________________________
_______________________________
___________________
_______________
Description of Activity
Organization/Location of Service
Date/Time of Service
Hours Competed
___________________________
__________________________
_______________________
_______________________________
Printed Name and Signature of Supervisor
Phone Number
Email Address
________________________________
_______________________________
___________________
_______________
Description of Activity
Organization/Location of Service
Date/Time of Service
Hours Competed
___________________________
__________________________
_______________________
_______________________________
Printed Name and Signature of Supervisor
Phone Number
Email Address
_________________________________
_______________________________
___________________
_______________
Description of Activity
Organization/Location of Service
Date/Time of Service
Hours Competed
___________________________
__________________________
_______________________
_______________________________
Printed Name and Signature of Supervisor
Phone Number
Email Address
OSSC- Community Service Completion Form
Student full name _________________________________
Student ID _______________________________________
Student Email ____________________________________
Email form to
judicial@uark.edu
or
Return to Pomfret Hall B110 (Entrance at the circle drive facing Clinton Ave)
Attention: Student Conduct
Contact number for questions: 479.575.5170
Total Hours _________________
________________________________
_______________________________
___________________
_______________
Description of Activity
Organization/Location of Service
Date/Time of Service
Hours Competed
___________________________
__________________________
_______________________
_______________________________
Printed Name and Signature of Supervisor
Phone Number
Email Address
__________________________________
_______________________________
___________________
_______________
Description of Activity
Organization/Location of Service
Date/Time of Service
Hours Competed
___________________________
__________________________
_______________________
_______________________________
Printed Name and Signature of Supervisor
Phone Number
Email Address
_________________________________
_______________________________
___________________
_______________
Description of Activity
Organization/Location of Service
Date/Time of Service
Hours Competed
___________________________
__________________________
_______________________
_______________________________
Printed Name and Signature of Supervisor
Phone Number
Email Address
________________________________
_______________________________
___________________
_______________
Description of Activity
Organization/Location of Service
Date/Time of Service
Hours Competed
___________________________
__________________________
_______________________
_______________________________
Printed Name and Signature of Supervisor
Phone Number
Email Address
________________________________
_______________________________
___________________
_______________
Description of Activity
Organization/Location of Service
Date/Time of Service
Hours Competed
___________________________
__________________________
_______________________
_______________________________
Printed Name and Signature of Supervisor
Phone Number
Email Address
_________________________________
_______________________________
___________________
_______________
Description of Activity
Organization/Location of Service
Date/Time of Service
Hours Competed
___________________________
__________________________
_______________________
_______________________________
Printed Name and Signature of Supervisor
Phone Number
Email Address