MESA PUBLIC SCHOOLS HONOR FOR EXCELLENCE IN SERVICE LEARNING
OPTION B: STUDENT APPLICATION
FOR EXTRACURRICULAR SERVICE
DIRECTIONS: Complete one application for each club or organization for which you serve. For example,
complete one for a school club’s service activities, one for volunteer work at an animal shelter, and another one
for the service you will do at church this year.
THESE ACTIVITIES MUST BE PRE-APPROVED. THEN YOU WILL RECEIVE A TIMECARD.
RETURN THIS FORM TO SERVICE LEARNING COACH _____________________ IN ROOM________.
Name________________________________________________ MPS 6 digit student #_____________
High School ___________________________________________ Year of Graduation _______________
Student/Family Phone ___________________________________ Email__________________________
Organization _______________________________ Supervisor Name____________________________
Where are you doing your service?
Who will sign your timecard?
City __________________ Phone ________________ E-mail__________________________________
1.
Who will you be helping?
2. What service will you be performing to help those people, animals, or places? (Use verbs!)
3. How will these people, animals, or places benefit from your help?
4. What are three or more skills you will learn through your service?
5. Select two of the Common Core skills located on the reverse side and predict what you will learn at your
service site. (Write them here.)
I do hereby apply for the MPS Honor for Excellence in Service Learning.
Student Signature _________________________________________
Date ________________
I support this student’s application for the MPS Honor for Excellence in Service Learning.
Parent Signature ___________________________________________
Date ________________
Service Learning Coach Signature________________________________
Revised 7/24/13
Date ________________
SKILLS YOU MIGHT LEARN THROUGH YOUR SERVICE
The following list gives you ideas for Question #4. You do not have to pick from this list; these are just
suggestions. What skills or knowledge would you like to learn, or further develop, while you are serving
the community?
How
How
How
How
How
How
to
to
to
to
to
to
be a leader
How to be more assertive
How to set a goal and meet it
lead a meeting
How to organize a project
How to speak in public
solve a problem
How to take minutes for a meeting How to work as part of a team
keep paperwork organized
How to follow school procedures when organizing a service activity
write business-style e-mails
How to create a persuasive video or power-point
take the initiative when needed
How to research a community or global issue
COMMON CORE SKILLS I WILL LEARN AT THIS SERVICE SITE
(You will need to show evidence of this in your reflection)
1. Demonstrate independence in your work habits at your service site.
2. Build strong content knowledge of the organization you are serving. What do they do? What is
their history?
3. Respond to varying demands of audience, task, purpose, and discipline. How do you speak in
different situations: a formal presentation, speaking with adults, speaking with peers, speaking
with younger children?
4. Comprehend as well as critique. Show a depth of reflection in your presentation.
5. Value evidence. Use detailed examples in your presentation. Be specific.
6. Use technology and digital media strategically, capably, and appropriately.
Revised 7/24/13