Blinn College

Dental Hygiene Program

Community Service Log

Student’s Name:

Month/Day of Birth:

* Community Service must occur between the following dates: Feb. 1, 2026 – Jan. 31, 2027

Date of Event/Place

Total hours of participation

Name of Event

Address

Phone #

Name of Supervisor

Supervisor’s Signature

Date

Date of Event/Place

Total hours of participation

Name of Event

Address

Phone #

Name of Supervisor

Supervisor’s Signature

Date

Date of Event/Place

Total hours of participation

Name of Event

Address

Phone #

Name of Supervisor

Supervisor’s Signature

Date

Date of Event/Place

Total hours of participation

Name of Event

Address

Phone #

Name of Supervisor

Supervisor’s Signature

Date

TOTAL HOURS:

PROGRAMS

VISIT

APPLY

The Blinn College District is accredited by the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC) to award associate degrees. The Blinn College District also may offer credentials such as certificates and diplomas at approved degree levels. Questions about the accreditation of the Blinn College District may be directed in writing to the Southern Association of Colleges and Schools Commission on Colleges at 1866 Southern Lane, Decatur, GA 30033-4097, by calling (404) 679-4500, or by using information available on SACSCOC's website (www.sacscoc.org).

The Blinn College District does not discriminate on the basis of race, color, national origin, sex, or disability. For information regarding Title IX, ADA, Section 504, and other anti-discrimination coordinators, see the Student Title IX page.

Application Form Community Service Log Observation Log Recommendation Form Application Completion Form Blinn College Dental Hygiene Program Application