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Blinn College PTA Program
Documentation of Community Service Form
Applicant Name
Business or Event Name
Business or Event Location
Description of community service duties completed by student
Service Dates and Times
| Date | Time In | Time Out | Total Time |
|---|---|---|---|
Total Hours:
Supervisor Verification
Supervisor Signature
Supervisor Printed Name
Supervisor Phone Number
Supervisor Email Address
Note: Applicant may submit a written letter on official letterhead of the business or event where community service hours were completed, in lieu of this form. The letter must contain, at minimum, a description of duties completed, total hours completed, and the official signature of the supervisor or event coordinator.