CENTRAL FALLS HIGH SCHOOL COMMUNITY SERVICE FORM
Student name _____________________ Date __________________
Organization Name ______________________ # of Hours________
For each item, please check off in the box on the right if the student completed the item listed in a satisfactory manner or if you feel they need improvement in that area.
Satisfactory = S
Needs Improvement = NI
Not Applicable = NA
S NI NA
1. Interacted with others in a courteous and tactful manner □ □ □
2. Cooperated with others and worked well in a team □ □ □
3. Accepted individual differences □ □ □
4. Showed up on time and was prepared □ □ □
5. Followed written and oral instructions □ □ □
6. Demonstrated honesty and accepted responsibility for □ □ □
personal actions
7. Accepted supervision willingly □ □ □
8. Managed time effectively □ □ □
9. Followed safety rules and regulations □ □ □
10. Used effective communication skills □ □ □
11. Greeted people in an appropriate manner □ □ □
12. Maintained a well-groomed professional appearance □ □ □
______________________
(Authorized signature)
Please use reverse side of this form for any additional comments.
Click HERE to download printable version.
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COMMUNITY SERVICE PROJECT/EVENT PARTICIPATION
Criteria:
In order for a student from Central Falls High School to meet the standards required for submitting a community service project or community service event participation into his/her portfolio, the student shall demonstrate the following:
- Evidence of participation in a specific community service event provided in the form of a letter including the date and description of event. Letter shall specify what the student’s participation entailed, signed by a person in authority and written on the organization’s letterhead
- Student-oriented task validation sheet completed by the student, with a signature of validation signed by one of the following members of the Central Falls High School staff:
1. Student’s teacher,
2. Guidance counselor, or
3. Advisor
- Either a written paragraph or persuasive essay written by the student explaining in their own words what activity they participated in following these guidelines:
- In the form of a paragraph the student shall describe how it made he/she feel to assist in the efforts of the chosen organization or;
- In the form of a persuasive essay, the student shall describe why he/she chose that particular agency/cause, based on the positive impact that it has within the community
- Reflection sheet completed by the student connected to appropriate Learner Outcome(s) as provided in the Central Falls High School Student Portfolio Handbook
- The final product shall be brought to the student’s guidance counselor for review and the appropriate school-wide rubric (written report or persuasive essay) shall be completed by their guidance counselor to show whether or not proficiency has been met
Once all of the above criteria have been met, a student at Central Falls High School shall bring this task to their Advisor for entrance into their working portfolio for possible submission into their graduation portfolio.
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