Student Tracking Sheet
Name: ____________________________
Course: ___________________________
Semester: _________________________
Professor: _________________________
Community-Based Organization: __________________________________________
| Date | Time In | Time Out | Hours | Daily Total |
|---|---|---|---|---|
Total Hours: ___________________
I hereby certify that the hours listed above are true and correct for my service placement.
Student Signature: ______________________________________________
I hereby certify that I supervised the service hours completed by the above named student and they are true and correct.
Site Supervisor: ___________________________ ___________________________
Print Signature
Supervisor Phone
Number/Email:___________________________________________________________
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