COMMUNITY SERVICE
**REQUIREMENT FOR GRADUATION AT REVIVAL CHRISTIAN ACADEMY

NAME:      	GRADE:    	

DATE	HOURS	AGENCY	TYPE OF WORK	SUPERVISOR’S SIGNATURE	PHONE	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	
     	    	     	     		     	

Total Hours:     	       Parent Signature: ________________________________________

                                            Date: ______________________

Community Service – Volunteer work – 50 hours for the 4 years you are enrolled at Revival Christian Academy in grades 9th – 12th.  No money or credit may be given for these hours.  Community Service form must be signed off by an adult in the community and turned into the Revival Christian Academy office to be placed in your files.