Student Service Learning Hour Log

Students, please use this form to record the number of hours per week that you serve at the placement site.  
When you have completed your service-learning hours, please turn this report in to your instructor.

Student Name:  	_________________________________________________________

Phone Number:	_________________________________________________________

Agency:		_________________________________________________________

Supervisor's Name: ________________________________________________________


Date		Time In	Time Out		Supervisor's Approval 	Total Hours


























Ending Date:			____________________________________________________

Total Hours Completed:		____________________________________________________

Supervisor's Signature:		____________________________________________________

Supervisor's Phone Number:	____________________________________________________