MESA PUBLIC SCHOOLS HONOR FOR EXCELLENCE IN SERVICE LEARNING
OPTION A: CURRICULUM-BASED SERVICE LEARNING
TEACHER REPORT FORM
Option A, "Curriculum-Based Service Learning," occurs when the classroom instructor
uses service learning as an instructional methodology. Through a particular class, students are
involved in service to the community that has a direct correlation to and reinforces the course
goals and objectives. The amount, length and type of service involvement may vary. Service
may take place during or after the class hour/school day.
It is up to the classroom teacher to keep track of students' Option A hours throughout
the project or semester. At the end of the semester (or April 1st for teachers of graduating
seniors), the teacher submits this form and a list with each student's name, six digit permanent
number, and the number of hours earned to the school's Service Learning Coach. The students'
hours are then entered onto GENESIS and appear on their transcripts.
The hours that the teacher submits for each student will be a total of the number of
hours spent on service learning activities during the semester. The hours of the service action
itself are the base of their hours. Teachers may also include time spent preparing for a
specific activity, and time spent reflecting on or debriefing the experience afterwards. There
is no "cap" on the number of hours a student can earn per semester; it is just important that
the hours submitted have integrity.
Here are a couple examples to clarify "what counts":
 Band students march in the Civil Rights Day Parade. They each get 4 hours for the parade day, 3
hours for a special practice for the parade, and 1 hour for analyzing in class how their performance
went. Fundraising performances are not eligible. 8 hours total.
 English/Language Arts students write letters soliciting donations from businesses. They spend 2
hours learning how to write a business letter, 1 hour writing and editing their letters, and 3 hours after
school organizing and delivering their donations. They write a reflection journal and have a discussion on
the successes and challenges of the activity for 1 hour. 7 hours total for most students; 10 hours total
for the students who contributed extra time at lunch.
 Sports trainers spend 3 hours after school, about 3 days a week for 18 weeks, accompanying teams
to athletic competitions and assisting the athletes and coaches. The other 2 days of the week they
spend about 1 hour a day learning new techniques, practicing skills and analyzing their recent procedures.
Travel and hanging out times does not count. 198 hours total for one semester.
 Woodworking students spend 3 hours learning the safety rules for the machines they will be using to
mass produce toys for needy children, 10 hours actually making the toys and 1 hour assessing the quality
of the toys and their work on the project. 14 hours total. Students who spend extra time after school
on the project or help deliver the toys may receive additional hours.
Thank you for helping the students earn their Honor for Excellence in Service Learning
by completing this form and submitting it to the Service Learning Coach. Your submission of
even a few hours may help students earn their "gold seal." (Over, please…)
MESA PUBLIC SCHOOLS HONOR FOR EXCELLENCE IN SERVICE LEARNING
OPTION A: CURRICULUM-BASED SERVICE LEARNING
TEACHER REPORT FORM
Teacher Name_____________________________ Course__________________________
School__________________Teacher Phone______________ Date submitted____________
1. Description of Service Activity (What was the general project?)
2. Dates of Activities (When did the activities take place?)
3. Preparation (What skills, knowledge, or content did the students learn in preparation for the
actual service?)
4. Action (What was the service itself?)
5. Reflection (How did the students describe what they did, what they learned, and analyze and
evaluate the effect of their service on the recipients and themselves?)
6. Attach a copy of your class list with each student's name, six digit number, and the number of
service hours earned by the student, including preparation, action, and reflection. (The number
of service hours may vary from student to student.)
7. What short description ("20 characters") should be entered into GENESIS for this activity?
(Suggestions are course title and project title.)