MESA PUBLIC SCHOOLS
HONOR FOR EXCELLENCE IN SERVICE LEARNING
OPTION A: CURRICULUM-BASED SERVICE LEARNING
TEACHER REPORT FORM
Teacher Name: Click here to enter text.
School: Mountain View
Course: Click here to enter text.
Date: Click here to enter a date.
Name of Course and Name of Service Project:
Click here to enter text.
Short Description of the Project: 2-3 sentences stating what the service was, when it took
place, and who benefited.
Click here to enter text.
Student Hours: Attach a copy of your class list(s) with each student's name, six digit number,
and the number of service hours earned by each student, including preparation, action, and
reflection. (The number of service hours may vary from student to student.)
THANK YOU FOR SUBMITTING THIS
TO JESSICA CHUPP, ROOM 724
or email to jmchupp@mpsaz.org