Student Service Learning Activity Verification

STUDENT INSTRUCTIONS: (NOTE: THIS DOCUMENT HAS TWO PAGES AND MUST BE FILLED OUT COMPLETELY):

1. Complete Section I (Student Information) on page 1 of this form prior to the service-learning opportunity and Section III (Reflection) on page 2 of this form after the service-learning opportunity is completed.

2. Ask the adult supervisor from the community organization to complete Section II (Community Organization Information).

3. Submit this completed form to your school’s SSL Coordinator by the appropriate deadline:

•  Last Friday in September (recommended): SSL forms for service completed during the summer
•  First Friday in January (recommended): SSL forms for service completed during the summer and 1st semester
• Last Friday in March (REQUIRED): SSL forms for service-learning hours to count towards the Certificate of Meritorious Service (high school seniors) or the Superintendent’s SSL Award (middle school)
• Last Friday in May (REQUIRED): DEADLINE for all SSL forms for service completed during the current school year.

Student Service Learning Activity Verification	80 K	English
Verificación de Actividad de Aprendizaje Mediante Servicio Estudiantil	76 K	Spanish
Vérification du Service Communautaire par les Élèves	75 K	French
Chứng Minh Hoạt Động Dịch Vụ Học Vấn Học Sinh	136 K	Vietnamese
學生服務學習活動核實表	147 K	Chinese
학생봉사활동증명서	117 K	Korean
የተማሪ የአገልግሎት ትምሀርት እንቅስቃሴ ማረጋገጫ	99 K	Amharic
Verificação de Atividade de Aprendizagem Mediante Serviço Estudantil	76 K	Portuguese

Forms require Adobe Acrobat Reader 8 or higher. Get Acrobat