Service Hour Report Form

Notre Dame de Sion

Fill in this form completely and turn in to the Service Office (please print or type)

Your Name
Class of
	Which agency or group benefited from this service?
Organization Name
Street Address
City, State Zip
Telephone (business)

Circle the type(s) of service you did (if more than one category, divide your hours between them)

Immediate Communities (serving current or former schools, your church, helping extra-curricular clubs, etc.)

Practical Work (hands-on, behind-the-scenes work that helps local non-profit organizations function)

Working with Marginalized People (working directly face-to-face with those who are poor, oppressed,
marginalized, ill, elderly, disabled, etc.)

What did you do?

Where?

When?
(times, dates-mm/dd/yr)

Total Hours Served ___________

Signatures

Student signature

Parent/Supervisor name (print)

Parent/Supervisor signature

Answer one of the following questions on the back of this sheet:

· Describe what you learned about the poor, suffering and/or marginalized (as real persons, not as an abstract group).

· Describe what you learned about your social responsibility as a faith-filled person.

· In this situation how are both direct service and systematic change needed?

· Describe an ethical issue involved in this situation.