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 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

Student Service Learning Activity Verification	95 K	English
Verificación de Actividad de Aprendizaje Mediante Servicio Estudiantil	58 K	Spanish
Vérification du Service Communautaire par les Élèves	59 K	French
Chứng Minh Hoạt Động Dịch Vụ Học Vấn Học Sinh	122 K	Vietnamese
學生服務學習活動核實表	195 K	Chinese
학생봉사활동증명서	212 K	Korean
የተማሪ የአገልግሎት ትምሀርት እንቅስቃሴ ማረጋገጫ	74 K	Amharic
Verificação de Atividade de Aprendizagem Mediante Serviço Estudantil	59 K	Portuguese

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