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Individual Student Service Learning (SSL) Request

About this Form

Form number: 560-50

Audience:  Students

Last revised: August 2021

Related Forms

Form 560-51 - Student Service Learning Activity Verification

Form 560-51A - Organization Responsibility and Assurance Certification Document

STUDENT INSTRUCTIONS: This form is for students to pursue a Student Service Learning (SSL) opportunity that is not identified on the Montgomery County Volunteer Center (MCVC) website. The names of nonprofit, tax-exempt organizations that have certified compliance with MCPS Guidelines for SSL can be found on Students should be familiar with the Seven Best Practices of Student Service Learning (see page 13 of the MCPS Student Service Learning (SSL) 2018–2019 Guide for Students and Families). Students should complete this form by typing into this interactive form, or print legibly in blue or black ink, obtain parent/guardian approval, and submit it to their school-based SSL coordinator at least 2 weeks prior to starting the SSL activity.

STUDENT FOLLOW UP (if activity meets MCPS Guidelines for SSL after review by the MCPS SSL coordinator—see page 2 of the MCPS SSL Guide for Students and Families): Documentation of all service is due to the school-based SSL coordinator must be completed on MCPS Form 560-51, Student Service Learning Activity Verification Form, by the recommended or REQUIRED dates below: (please note that all SSL hours are available on the myMCPS student portal after they have been verified by the school-based SSL coordinator. In order for the SSL hours to be reflected on the student’s report card, the “recommended” dates below must be met.)
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)—Recommended 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.

Adobe PDF Individual Student Service Learning (SSL) Request94 KEnglish
Adobe PDF Solicitud Individual para Aprendizaje Mediante Servicio Estudiantil68 KSpanish
Adobe PDF Formulaire de Demande pour Le Service Communautaire Individuel91 KFrench
Adobe PDF Đơn Yêu Cầu Dịch Vụ Học Vấn Học Sinh Cá Nhân (SSL)131 KVietnamese
Adobe PDF 個別學生服務學習活動(SSL)申請表277 KChinese
Adobe PDF 학생 봉사학습활동(SSL) 신청서250 KKorean
Adobe PDF የተማሪ የአገልግሎት ትምሀርት (SSL) የግል ጥያቄ89 KAmharic
Adobe PDF Solicitação Individual de Aprendizagem Mediante Serviço Estudantil (sigla em inglês, SSL)91 KPortuguese

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