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Form number: 560-51
Audience: Students
Last revised: August 2022
Form 560-50 - Individual Student Service Learning (SSL) Request
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. 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. SECTION I. STUDENT INFORMATION—To be completed by the student prior to review from
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