SSCE Endorsement Form

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Criteria 5 of the State Seal of Civic Engagement requires that you (teacher/mentor) fill out this endorsement form for the student that you have supported through their civic engagement project.

Student Name *

Student's full PVUSD email address *

Their email address is their student ID number followed by @pvusd.net . For example: 123456@pvusd.net

Name and contact information of recommender. *

How do you know the student named above? *

Civically engaged individuals demonstrate characteristics of civic mindedness. Please check all that apply regarding the ways you have witnessed characteristics of civic mindedness in the individual named above.

Concern for the rights and well-being of their fellow community members

Desire to contribute to the common good

A proactive commitment to equity, inclusivity, racial and ethnic diversity and fairness

Appreciating and seeking out a variety of perspective and valuing differences, including those voices that are underrepresented or marginalized

Demonstration of a sense of civic duty and local, state, national or global levels

Awareness of the value of their own experiences and the knowledge of their own community to make positive social, political, environmental or economic contributions to be the greater good

Respect for the contributions of other members of society who do not share the same racial, economic, cultural or political background

Demonstrating empathy through inclusion and helping to elevate the voices of others

Standing up for oneself or another student who is experiencing bullying, harassment, discrimination, exclusion or unwanted attention

Leading a group to work toward providing a common good

Other:

Required

Please provide a specific example that demonstrates at least one of the civically-minded qualities you marked above.
*

If you would like to share anything else, please feel free to add it here or include an additional letter of support.

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