Service Learning Reflection Form - Carroll County Public Schools printable pdf download

Service Learning Reflection Form - Carroll County Public Schools

Time Record

Service-Learning Reflection Form

To be completed by adult site supervisor

Dates of service:

Note:

Students, parents, and individuals/organizations who accept student

____/____/____ to ____/____/____

service volunteers should note Guideline #1 (found on the reverse side)

PRIOR to service activity.

HOURS EARNED:_______________

PLEASE PRINT OR TYPE

____________________________________________

Signature of Adult Project Supervisor

GRADE_________HOMEROOM TEACHER_____________________

STUDENT

NAME_________________________________________________________

____________________________

Last

First

ACTIVITY

SPONSORING ORGANIZATION/CLASS_________________________________________PHONE__________

Reflection to be completed by student: (If you need additional space please attach a separate sheet) Now that you

have completed your service-learning project you are ready to write a description of your activity. Tell why you chose to

do this project. What were your responsibilities and what did you actually do? How did your actions make you feel and

how do you think the community benefitted from your actions? Would you select this project again?

Signatures:

Student_______________________________________DATE___________

Parent________________________________________DATE___________

This completed form must be returned to the school Service-learning Coordinator

within one year from the time the service is complete.

Confirmation/Approval of Service-Learning Hours

Upon approval of your service-learning activity, this section will be returned to you for your records.

Please complete the following:

Student Name:____________________________________Homeroom Teacher:__________________

Activity:_____________________________

(To be completed by the school-based Service-Learning Coordinator )

Hours Earned:______

Dates of Service:________________

Signature: Service-Learning Coordinator_________________________________Date:_____________

Service Learning Reflection Form - Carroll County Public Schools