Montgomery County Public Schools

Student Service Learning Activity Verification

STUDENT INSTRUCTIONS: Complete Sections I and III of this form legibly in blue or black ink. The nonprofit tax exempt 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)—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.

Student Service Learning Activity Verification	436 K	English
Verificación de Actividad de Aprendizaje Mediante Servicio Estudiantil	431 K	Spanish
Vérification du Service Communautaire par les Élèves	430 K	French
Chứng Minh Hoạt Động Dịch Vụ Học Vấn Học Sinh	437 K	Vietnamese
學生服務學習活動核實表	581 K	Chinese
학생봉사활동증명서	460 K	Korean
የተማሪ የአገልግሎት ትምሀርት እንቅስቃሴ ማረጋገጫ	448 K	Amharic

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