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MESA PUBLIC SCHOOLS SILVER SEAL FOR EXCELLENCE IN SERVICE LEARNING
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STUDENT TIME CARD FOR OPTION B: EXTRA CURRICULAR SERVICE LEARNING
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ALL TIME CARDS NEED TO BE TURNED IN TO YOUR SCHOOL SERVICE LEARNING COACH
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Please make arrangements to do your reflection with your school's Service Learning Coach Ms. Forster.
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Student:
________________________________________
Phone:
___________________________________
Student ID:_____________
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School:
________________________________________
Email:
____________________________________
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Organization:
________________________________________
Supervisor who will be signing your time card:
_________________________________________
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Complete the following timecard every day you volunteer. It may include organizing and setting up your service activities and the service action itself. (For example, you may record orientation or training sessions, meetings to plan a project, and volunteering at the activity.)
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DateTime of Day
(ex. 3-4:30PM)		# of Hours
(eg 1.5) 		LocationWhat service did you perform (use verbs)Adult Initials
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Total Hours (round to the nearest .5): Bring completed timecard to Ms. Forster in the Title I Office to schedule your reflection.
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Supervisor Evaluation (REQUIRED)
Please comment on the qualiy fo the service learning of this student, including his/her development of skills, responsibility, interpersonal relations, work ethic, and service ethic.
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Supervisor Signature:Date:
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