Community Standards and Student Advocacy (CSSA)
~Community Service~
Educational Sanction Assignment Due Date: ____________________
Center of Civic Engagement and Community Service Staff,
The following student (print full name): _________________________________________ has been given
an educational sanction requiring that they complete ___________ community service hours. Please let this
document serve as confirmation that the student is aware of the following:
1. It is the student’s responsibility to contact the center to schedule their community service hours within
two weeks of receiving their conduct decision letter.
2. It is the student’s responsibility to ensure their service hours are scheduled and completed within the
assigned deadlines.
3. It is the student’s responsibility to sign an authorization to release information to the Office of
Community Standards and Student Advocacy for the following information: date(s) of scheduled service
hours and students’ compliance or refusal to complete required hours.
4. It is the student’s responsibility to inform the Office of CSSA prior to any due date(s) if personal
circumstances prevent the student from meeting any sanctioning requirements and/or deadlines.
______________________________________________________
Student Signature
Office Use Only
______________
Date
Staff Signature & Date
 The above student successfully completed the
community service educational sanction.
o Date of completion:_______________
 The above student did NOT successfully
complete the community service educational
sanction.
Community Standards and Student Advocacy
Office Location: A2120C
Phone: 708.235.2845
Email: [email protected]
Website: www.govst.edu/cssa