Valley Christian Schools
Service Learning Verification Form
(one form per Non-Profit)
All Middle and High School Students must complete this form and submit it to the Service
Learning Lead by the appropriate deadline. Late service learning hours will not be accepted.
•
September 30, 2016 - Service Learning between June 1 and August 30, 2016
•
January 13, 2017 - Service Learning between September1 and December 31, 2016
•
June 2, 2017 - Service Learning between January 1-May 31
Section to be completed by the student :
Student Name: ____________________________________________________________
Grade: _______
Email (if not VCS): __________________________________________
Student Assessment of Service Learning Opportunity
Discuss your opportunity (write 2-3 sentences minimum each question on a separate sheet OR submit a short film on your
YouTube channel answering these questions.):
1. What drew you to this non-profit organization?
2. What is the purpose or mission statement of the organization you served?
3. What were you hoping to contribute by volunteering here?
4. What did you contribute and how do you feel about it?
5. What impact does your service have on the community and the world?
6. What have you learned about yourself and others by serving here?
Valley Christian Schools | 7500 Inspiration Drive, Dublin, CA 94568 | 925.560.6200 | ValleyChristianSchools.org
Questions? Email Sara Heise at [email protected]
Service Learning Log
Date of Service Time of Service
Hours Earned
___________________________________________________________________________________
Section to be completed by Non-profit Organization Supervisor
Organization Name: ________________________________________________________
Address: ____________________________________ City: _________________________
Telephone: _________________________ Email: _________________________________
Can VCS contact you in regards to this student’s service? Yes No
Supervisor: _____________________________ Title: _____________________________
Signature: _______________________________________________________________
______________________________
Student Signature
_____________________________
Parent or Guardian Signature
______________________
Date
______________________
Date
Valley Christian Schools | 7500 Inspiration Drive, Dublin, CA 94568 | 925.560.6200 | ValleyChristianSchools.org
Questions? Email Sara Heise at [email protected]