Student Name: ______________________________________ Homeroom: _____________

Yr. of Graduation: _______________ Counselor: _________________________________

Title of Organization: ________________________________________________________

Contact Person: _________________________ Phone Number: ______________________

Date(s) of Service: ________________________________ # of Hours: _________

Describe the nature of your community service: what did you do, where was it done, etc.?

__________________________________________________________________________

__________________________________________________________________________

If this project has not been pre-approved or does not appear on the Community Service website list, please describe how your hours reflect the guidelines explained on the back of this sheet?

____________________________________________________________________________

____________________________________________________________________________

Contact person/service supervisor's signature confirming the amount of service:

___________________________________________ Date: _____________

Student's signature verifying that all information submitted is accurate:

___________________________________________ Date: _____________

Parent/Guardian's signature:

___________________________________________ Date: _____________

Once this form is completed, please make a copy for yourself and then deposit it in the community service box in any guidance office. The Social Action Committee will review each form. Those approved will be passed along to your guidance secretary for processing; those questionable will be sent back to you for further clarification; those denied will be sent back to you with an explanation and the process for appeal.
______________________________________________________________________________
FOR SOCIAL ACTION COMMITTEE USE ONLY:

Date Reviewed: __________ Approved: _____ Initial: __________Denied: ______ Initial: _______ Questioned: ______ (see below or address highlighted area)
Rev. 5/2006

 

Each student at Lexington High School must perform a minimum of forty hours of community service during their high school career (transfer students must perform 10 hours per year of attendance at LHS). Students may begin accruing hours beginning the summer prior to ninth grade. The community service requirement may be satisfied by participation in either a single activity or a combination of approved activities

A community service activity must conform to the following guidelines.

• It must be performed without compensation to the student. Examples: Court-ordered community service will not be accepted. Paid work will not be accepted. Work receiving academic credit will not be accepted.
• It must benefit at least one person other than the student or the student's relative(s).
• It must not be associated with religious ceremonies, services, education, proselytizing, or fund-raising. A non-religious activity performed through a religious community, but which does not benefit a religious community or place of worship directly, may still be considered.
• Political campaigning or work benefiting political organizations or causes directly cannot be accepted. 

Credit must be earned according to the following guidelines.

• The service must meet the prior definition.
• The service may not be used to earn credit for more than one program or organization. For example, Peer Tutors may earn community service credit toward LHS or NHS requirements, but not both; students who volunteer in school offices may receive either personnel service credit or community service credit, but not both.
• The service can be performed for an approved organization (list available on the Senate website, see below) or the service must be approved beforehand by the Social Action Committee of the LHS Senate (Pre-approval forms available in the Guidance areas or on the Senate website, see below). You may also submit a form for a service that has not been pre-approved, but you run the risk of having your hours denied for not meeting the guidelines of community service.
• Completed and legible Community Service Forms must be placed in your Guidance Counselor's mailbox. Incomplete or late forms may delay the processing of your hours.

  Community Service information and forms can be found in the Guidance offices at the High School or on the website of the LHS Student-Faculty Senate: lhs.lexingtonma.org/senate.