Brunswick Academy

Community Service Record

            The Board of Directors of Brunswick Academy has instituted a mandatory requirement for ALL students entering Grades 9-12.  Each student will be required to complete at least ten (10) hours of community service each year.

            Community service provides assistance to our local businesses and institutions while allowing students to become active participants within the same.  It allows students to explore career interests.  Community service affords students the opportunity to gain firsthand knowledge of the resources within their community and also to learn that they are a resource as well.  It benefits our students through the rich learning experiences they gain as well as provides stronger student applications for college through the documenting of this volunteer work.  We are including the form for students who would like to begin heir service this summer.

            Mrs. Deborah Owen will serve as the contact person for the school.  Please send this form to the Guidance Office when it is completed.  It will be kept on file.

Student’s Name:  ______________________________________________________

                             First                                    Middle                                     Last

Business, Institution, or Organization:  ___________________________________

                                                                                                Name

                                                            _______________________________________

                                                                                             Address

                                                            _______________________________________

Describe work performed:  _______________________________________________

_____________________________________________________________________

Date:                                       Hours Worked:

_____________                      _____________

_____________                      _____________

Supervisor’s Name:  ____________________________________________________

Supervisor’s Signature:  _________________________________________________

Examples of businesses, institutions, or organizations:  Day camps, Day Care, Churches (assisting with church bullentins, Bible School, cutting grass, cleaning area of church, etc.), Nursing Homes, Hospitals, Assisting the Elderly, Adopt-A-Highway, Schools (such as moving books, cleaning, etc.), Library, American Red Cross, Rescue Squads.  The Bread Box of South Hill, and so forth.  Work for which you are being PAID will NOT count as volunteer hours.  Extracurricular activities will not count.  Babysitting will not count.  Work is not to be done for relatives.  Persons signing this documentation MAY NOT be relatives.  If you have questions, you may call Brunswick Academy at (434) 848-2220.

Form received in the guidance office on this date:  ___________________

_________________ hours are credited for 20____ - 20 ____ per _______________.