Service Learning Test

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Students must obtain pre-approval from their supervisor before completing this form.

1) All activities must be pre approved two weeks prior to the event/start of activity.

2) Prior to obtaining final approval students must be granted approval from the teacher supervisor, and activities director.

3) Cleaning-up the area and equipment is the responsibility of the students who are running the event. If this does not occur, the group will be banned from fundraising or hosting an event for two to four weeks.

4) Risk assessment and parent permission forms must be completed before an off campus activity can be approved.

Name of person completing form:

Email of person completing form:

Name of Group:*

Name of supervisor:*

Title of the Activity*

Description of the Activity:*

Beginning Date of Activity:*

Ending Date of Activity:*

In what ways does your proposed event address an authentic need? What population will the service involve? Where will the service take place?*

How will the event be a reciprocal / shared learning experience for both us and the group you are working with?*

If raising funds how will the money be used?

If yes, list the Business Office code for this event:

Student members of the activity/project. Please indicate the grade level of each participant.

Student Name (Leader):*

Grade (Leader):*

Other Members

Name	Grade

Equipment or space needed – be specific – (a separate work order may need to be completed.) What exactly will I need? How much will it cost? Please plan for transportation and costs involved in this activity. (ISY provided transportation = $5USD for every 10Km)*

Approval has been granted to use the location (i.e. classroom, gym, or learning space).*

Yes
No

Locations:*

Do I need help with anything?*

Yes
No

what do I need help with? Who will I ask for this help?*

ISY security has been informed. (Only necessary if the event takes place outside of the school day or event involves outside community members.)*

Yes
No

Approval Code:

To be filled by Supervisor or Principal

Supervisor's signature:*

Secondary Principal Signature:*