National Honor Society

Hendersonville High School Chapter

OFFICIAL SERVICE HOURS DOCUMENTATION FORM

This form must be completed and submitted for each service the member completes.
Service hours will not be recorded without this documentation AND a signed receipt, which is
provided immediately when this form is turned in.
Student Name: __________________________________________________________
Date of Service: _________________________________________________________
Place of Service: _________________________________________________________
This place is on the Approved Community Service Venues list.
This opportunity was approved as an Alternative Service Opportunity
(documentation and sponsor signature required) BEFORE the service was
completed.
Description of Service Performed: _________________________________________
_______________________________________________________________________
Number of Hours Served: ________________________________________________
Signature of Supervisor: _________________________________________________
Contact Information for Supervisor (phone/email): ___________________________
_______________________________________________________________________
How has this service helped your community, and what have you learned as a result of this
service? ________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
NHS Service Documentation forms can be turned in to Mrs. Kotler or Ms. Chalenburg during
scheduled NHS meetings. These forms MUST be handed to a sponsor in person so that the
member can be given a receipt for it.
No forms will be accepted where a receipt cannot be provided.