Community Involvement Activity Notification And Completion Form printable pdf download

Community Involvement Activity Notification And Completion Form

School: _____________________

Community Involvement Activity Notification and Completion Form

Students planning to begin their community hours in the summer preceding entry into Grade 9 are reminded to verify activities according to the guidelines listed on the

back of this form and submit proof of their completed hours to their secondary school after October 1

of the year obtained.

Date submitted: __________ Last Name: __________________________ First Name: ________________ Trillium # ________________

(yyyy-mm-dd)

Date

Hours

Organization

Description of Activity

Supervisor’s Name and

Supervisor’s

Principal’s/Designate’s

Completed

Phone Number

Signature

(*if required)

Total

I acknowledge that I am responsible for the monitoring and safety of my son/daughter during the completion of these hours

Hours

______________________________ Parent/Guardian Signature

*If the activity is NOT on the “Eligible List” (see back of this form), you must obtain your principal’s/designate’s signature BEFORE starting the activity.

Personal information on this form is collected under the authority of the Education Act and Municipal Freedom of Information and Protection of Privacy Act and will

only be used to document completion of community involvement hours.

For Office Use Only

Completion has been noted on the student’s OST.

_____________________________

____________

Signature of School Official

Date