40 Hour Community Involvement Form
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1
2Steps to Completing your Community
Involvement Activity
Community Involvement
1.
In consultation with your parents, CHOOSE a community
Activity Record
involvement activity (parent signature is not required if the
student is eighteen years of age or older)
.
Working Towards Your
2.
CONTACT the person or organization to explore the
possibility of a volunteer activity.
Ontario Secondary School Graduation
Diploma
3.
CHECK the Community Involvement Manual for the list
of eligible activities @
(Our Programs / Secondary Program / Graduation
Name:_________________________________
Requirements / Community Involvement Manual)
School: _______________________________
4.
ENSURE that no activities from the ineligible list appear
on this form.
Telephone: ______________ Grade: ________
5.
VOLUNTEER a minimum of 10 HOURS EACH YEAR.
Don’t leave it until you are in Grade 12.
School Year: ________ Principal: ______________
6.
COMPLETE the Community Involvement Activity
Record as you finish each activity.
7.
SUBMIT the form to Student Services when you have
completed 40 or more hours.
8.
KEEP a copy for your own records.
Personal information contained on this form is collected pursuant to the
current Education Act of the Province of Ontario and the Municipal
Freedom of Information and Protection of Privacy Act and will be used for
the purposes of the education of students. Questions about the collection
Our students, Our Future
of this personal information should be directed to the Freedom of
Limestone District School Board
Information Co-ordinator, Limestone District School Board, 220
Portsmouth Avenue, Kingston, Ontario, K7L 4X4, or (613) 544-6920, ext.
229
revised September 2011
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