Student Service Learning Activity Verification

STUDENT INSTRUCTIONS: Complete Sections I and III of this form legibly in blue or black ink. The registered nonprofit organization completes Section II.
Documentation of all service is due to the school-based SSL coordinator according to specific timelines. For detailed instructions on how to complete this SSL form, please watch the video at https://bit.ly/SSLForm101. In order to be reflected on the student’s report card each semester, students must submit MCPS Form 560-51, Student Service Learning Activity Verification Form, to the school SSL coordinator by the following recommended dates:

• Service completed during the summer—Recommended by Last Friday in September
• Service completed during the summer and 1st semester—Recommended by First Friday in January
• Service completed during the summer, 1st semester, and 2nd semester to be recognized for the Certificate of Meritorious Service (high school
• seniors) or the Superintendent’s SSL Award (middle school)—REQUIRED by First Friday in April
• Service completed during the summer, 1st semester, and 2nd semester—REQUIRED by First Friday in June
• ALL SSL Forms for service completed any time during the current school year, including the summer before the current school year, are REQUIRED

to be submitted to the school SSL coordinator no later than the first Friday in June.

Student Service Learning Activity Verification	90 K	English
Verificación de Actividad de Aprendizaje Mediante Servicio Estudiantil	127 K	Spanish
Vérification du Service Communautaire par les Élèves	68 K	French
Chứng Minh Hoạt Động Dịch Vụ Học Vấn Học Sinh	125 K	Vietnamese
學生服務學習活動核實表	125 K	Chinese
학생봉사활동증명서	106 K	Korean
የተማሪ የአገልግሎት ትምሀርት እንቅስቃሴ ማረጋገጫ	158 K	Amharic
Verificação de Atividade de Aprendizagem Mediante Serviço Estudantil	62 K	Portuguese

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