Champion Christian High School Service Form

We strive to learn and learn to serve with Jesus as our model.

To: Adult supervisor

From: Gloria Kerin--CCHS Principal

Thank you for providing a service opportunity for our students. Our goal is to further spiritual growth and develop students with a heart for ministry. Christian service has as its inspiration the life and teaching of Jesus Christ. Your cooperation with our school in this endeavor is greatly appreciated. Please fill out the information in this form and either return to the school or to the student.

Student:_______________________________ Agency or work site:_______________________

Date Served:___________________________ Phone:__________________________________

Hours served:__________________________ Signature:________________________________

Duties:________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Supervisor’s comments:__________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Supervisor’s Evaluation of Student’s Attitude and Performance (Circle all that apply)

Honest                        Willing to Work                     Friendly                      Perseverance

Compassionate           Leadership                   Conscientious

Student Comments and Evaluation of Service Project:

Please reflect on what you have discovered about yourself and others through this service effort.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Gloria Kerin, Principal

2166 Indian Head Road

Champion, PA 15622