Learning Through Service* Application Process *SERVICE LEARNING ACTIVITIES ARE SPECIFICALLY FOCUSED FOR NON-PROFIT ORGANIZATIONS.

Application Process Part I (to apply) 1. Student will: a. Complete application – top four lines and Part A (Student Proposal) - applications and a current list of service opportunities are available in the School Counseling Office and posted on bulletin boards throughout the school. b. Select Volunteer site – call agency contact person to obtain permission to participate c. Obtain parental permission to participate 2. Student’s Counselor will: a. Review application (1) approve (2) disapprove (3) describe conditions to be met b. Return application to student Application Process Part II (once hours have been completed) 1. Student will: a. Summarize their service opportunity (Part C of application) b. Sign application (Part C) c. Give supervisor evaluation section (Part D) to contact person at agency d. Submit completed application to your school counselor 2. Blue House Office Professional (Mrs. Reis) will: a. Maintain Learning through Service Log Books and grades. b. Log student hours in LTS Log Book and file student’s application in Log Book. (Log Books are kept in the Blue House Office). Applications are filed according to student’s year of graduation, separated alphabetically therein. c. Until the student fulfills the 10 hours of LTS, a designation in PowerSchool and on the student’s report card will be listed as “Incomplete.” Once the requirement is met, it will change to “Pass.”

Plainville High School Learning Through Service Program 47 Robert Holcomb Way Plainville, CT 06062 (860) 793-3220 x353 (School Counseling Department) FAX (860) 793-3231 Contact: Student’s School Counselor Student Name: Year of Graduation: Date of Proposal:

Student fills out this section

PART A

Student Proposal for Independent Service Project*

*SERVICE LEARNING ACTIVITIES ARE SPECIFICALLY FOCUSED FOR NON-PROFIT ORGANIZATIONS. 1. Describe your proposed project: 2. Sponsoring agency or organization:

3. Date this service will be/was completed: 4. Supervisor’s Name: Telephone Number: 5. Total number of hours proposed: Parent/Guardian signature on the following line indicated permission for the above project:

School Counselor fills out this section

PART B Learning through Service Response: approved not approved until conditions are met (see comments) disapproved Comments: Signed:

Date: Learning through Service Coordinator

PART C

Student Evaluation of Learning through Service Experience

Please evaluate your experience with this project. What did you gain and/or learn from this experience?

Student fills out this section

What changes, if any, would you recommend? (attach an additional sheet if necessary)

Student Signature:

Date: Thank you for serving your community.

PART D

Site Supervisor Evaluation of Learning through Service Plainville High School

Site Supervisor fills out this section and signs

has satisfactorily completed Student’s name hours of community service on (date completed) 1.

Did you/your organization/the community benefit from this service? Please comment on how.

Yes No

2.

If no, please explain below.

Would you like students to continue to serve with your organization? Yes No Supervisor’s Signature