Summer Service-Learning Honor Application 2019
Directions: Complete one application for each club or organization for which you serve. For Example, complete one for a school club's service activities, one for volunteer work at an animal shelter, and another for all the service you will do at church this year.

THESE ACTIVITIES MUST BE PRE-APPROVED. THEN YOU WILL RECEIVE A TIMECARD. THIS FORM WILL AUTOMATICALLY BE RECEIVED BY THE SERVICE LEARNING OFFICE.

STUDENT NAME (Capitalize correctly) *
Your answer
MPS STUDENT I D # *
Your answer
YEAR OF GRADUATION *
Your answer
STUDENT PHONE NUMBER (000-000-0000) *
Your answer
FULL ADDRESS (Capitalize correctly) *
Your answer
PARENTS' NAME and PHONE NUMBER *
Service Learning Coach MAY call for parent verification
Your answer
HIGH SCHOOL (you are or will be attending) *
Your answer
STUDENT PREFERRED E-MAIL *
Your answer
NAME OF ORGANIZATION *
Your answer
ORGANIZATION CITY (Capitalize correctly) *
Your answer
ORGANIZATION CONTACT PHONE OR EMAIL *
Your answer
NAME OF SUPERVISOR *
Your answer
Who will you be helping? *
Your answer
What service will you be performing to help those people, animals, or places? (Use verbs) *
Your answer
How will these people, animals, or places benefit from your help? *
Your answer
What are three or more skills you will learn through your service? (example: leadership, problem solving, organize a project, speak in public, teamwork, research an issue) *
Your answer
Service Learning Participation *
By reading and checking the following boxes, I agree to the terms and rules of Service Learning as listed below. If I do not complete these items my hours will not be counted toward the Honor for Excellence Award and will not be recorded on my transcript. Please check all the boxes to show understanding.
Required
Contact with Adults
I acknowledge that some activities of the Cooperative Education/Internship Program occur off school property and involve adults who are not employees of Mesa Public Schools. I acknowledge and accept that my son/daughter may be instructed by or work with a person whose work experience and background have not been investigated by Mesa Public Schools.
Parent/Guardian Signature *
Your answer
Submit
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