COMMUNITY SERVICE WORKSHEET

THIRD DISTRICT JUVENILE COURT
450 S STATE STREET - 2ND FLOOR
PO BOX 140431
SALT LAKE CITY, UT 84114-0431

NAME:
ADDRESS:

                                                                 
                                                                 
                                                                 

CASE NUMBER:
DATE OF BIRTH:

                                              
                     AGE:                

NJ

     

     

CT

     

     

ORDER TO BE COMPLETED

AMOUNT

DUE DATE

COMPLETED

COMMUNITY SERVICE HOURS

                 

                   

                       

RESTITUTION

                 

                    

                        

DATE

DESCRIPTION OF WORK

LOCATION

SUPERVISOR

# OF HOURS

SIGNATURES:

                                                        

JUVENILE:

                                                 

WORKER ACKNOWLEDGMENT:

                                                             

COMMUNITY SERVICE HOURS ASSIGNMENT GUIDELINES
FOR JUVENILE AND FAMILIES

Your youth has been ordered by the Court to work Community Service hours and it is your
child’s responsibility to complete this assignment.  As the parent(s)/guardian(s), it is your
responsibility to assess your youth in complying with this Court order by providing (1) support,
(2) supervision, (3) transportation, and (4) keeping accurate records of dates and hours the youth
has worked.

This assignment must be approved by the Court before beginning the work or program.

Documentation of hours worked must be received by the Court in order to verify that the
assignment has been completed.  Verification is also needed for program credit.

Some suggestions for your Community Service jobs and programs in your neighborhood are:

 

1.  Schools
3.  Neighbors or family member
     (65 or older, or disabled....
      yard work/gardening/errands?
5.  Churches 

2.  Charitable/non-profit agencies
4.  Substance Abuse Program
6.  Litter pick-up
7.  Others (MUST be approved by the Court)

ADHERENCE TO THE FOLLOWING IS IMPORTANT:

1.  The work must NOT BE HAZARDOUS.

2.  Neither the youth nor the parent/guardian are to receive any money or compensation for any
service performed.

3.  Most government (federal, state, county, and city) agencies or animal shelters are not
available for this assignment.

4.  Business/commercial enterprises are NOT approved or this assignment.

Please mail all documentation and refer any questions to:

THIRD DISTRICT JUVENILE COURT
450 SOUTH STATE
PO BOX 140431
SALT LAKE CITY, UT 84114-0431