Sacred Heart School
16 Morton Road, Anniston, Alabama 36205
Telephone (256) 237-4231

SERVICE HOURS REPORT

NAME OF STUDENT _______________________________________________________

NAME OF AGENCY ________________________________________________________

NAME OF SUPERVISOR ___________________________ PHONE _________________________

DATE	TIME (FROM – TO)	NUMBER OF HOURS	SIGNATURE OF SUPERVISOR
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
	TOTAL HOURS:

****This form is to be filled out by the supervisor, not the student.****

SUPERVISOR’S REPORT

NAME OF VOLUNTEER _________________________________ DATE_____________

NAME OF AGENCY ________________________________________________________

NAME OF SUPERVISOR ____________________________________________________

1.  What duties were assigned to the volunteer:



2.  What skills were utilized to perform necessary duties?



3.  Has the volunteer been on time?



4.  Did the volunteer abide by agency rules and requirements?

GENERAL APPRAISAL

Please evaluate the student volunteer in the areas listed below, using the ratings immediately below:

S = Superior

AA = Above average

A = Average

BA = Below average

U = Unsure

______ Ability to work with other volunteers

______ Ability to work with staff and supervisors

______ Rapport with clients

______ Attendance

______ Overall Effectiveness

Please make additional comments and suggestions  on back.

Hours completed _______ Supervisor’s signature _______________________________