Name __________________________________ Date _____________________________ Period: 4B

High School & Community Service Activities Record

Place an X for each corresponding grade you participated in the following school activities. Please be
extremely thorough in listing all activities.

Community Service (volunteer work)

Mission Bay Triathlon Race Crew
Silverstrands Marathon Race Crew
Bumblebee 5k Race Crew

Hours
4
4
4

Organizations, Clubs, Activities & ASB (please note any leadership roles)

9th 10th 11th 12th

X
X
X
9th 10th 11th 12th

N/A

Special Talents & Hobbies

Reading

9th 10th 11th 12th

X
X
X
X

Athletics, Cheer, Dance, Theater, Band

Basketball (Captain 10th grade year)
Track & Field (Main event: Long jump)

9th 10th 11th 12th

X
X
X
X

Awards, Honors, and Other Achievements

Principals Honor Roll
Perfect Attendance

9th 10th 11th 12th

X
X
X
X
X

Jobs
SeaWorld San Diego

9th 10th 11th 12th

X
X

Name __________________________________ Date _____________________________ Period ___

High School & Community Service Activities Record

(For University of California)
In addition to your courses and grades, we want to know about any honors youve received and how you spend your time
outside of school. Use this worksheet to prepare concise descriptions of your most significant awards and activities. You may
list up to five entries in each category, so think carefully about what you want to highlight. Also make sure to fully describe
each item (up to 160 characters) for admissions offices to best understand your involvement.
Coursework Other Than AG List the courses you took during high school, other than those
approved for UC admission, that demonstrate a particular focus or interest (e.g., language immersion
courses or nontransferable college courses).

Course Name

9th

10th

11th

12th

Description of Course

Sociology 101
Introduction to Sociology
English 101
Introduction to college English
Math 96
Freshman college math
Philosophy 101
Introduction to Philosophy
Educational Preparation Programs List your participation in educational or academic

X
X
X
X

preparation programs that are designed to help students prepare for university study. These programs may include
academic enrichment programs sponsored by colleges/universities, research programs and study-abroad programs.

Program Name
N/A

Hours
Per
Week

Weeks
Per
Year

3
3-4.5
4.5
3

14
36
36
14

9th

10th

11th

12th

Hours
Per
Week

Weeks
Per
Year

9th

10th

11th

12th

Hours
Per
Week

Weeks
Per
Year

Description of Program

Volunteer and Community Service List unpaid work only.

Organization

Description of organization and your responsibilities

Mission Bay
Triathlon
Silverstrands
Marathon Race Crew
Bumblebee 5k Race
Crew

Race Crew that gave water to racers

N/A

Part of the race crew that gave water to racers

N/A

Bumblebee Tuna company fundraiser; part of the

race crew that gave water to racers

N/A

Work Experience

List paid work only.

Job Title
Sales Clerk III

9th

Responsibilities

10th

Cash handling in the stadium shows. I would

greet guests and show off company
merchandise to sell to them. I also worked in
stores with a cash register and was required to
handle guests complaints.

11th

12th

Begin
Mo/Y
r

12/1
5

End
Mo/Y
r

Hours
Per
Week

Hours
Per
Week

(Summer)

(Sch. Yr)

9/16

28

16

To what use have you or will you put your earnings?

Awards and Honors List and briefly describe the most significant awards you have received since the beginning of 9th grade.
Award or Honor

Principals Honor
Roll

Award or Honor Type

Description of Award or Honor

Academic

Other

Having a 4.0 or above G.PA.

Extracurricular Activities List and briefly describe the activities you have been involved in
since the beginning of 9th grade.

th

Activity

Description of Activity

Basketball

Played for the JV basketball team

th

10

th

11

12

th

Date
Receive
d

20142015

Hours
Per
Week

Hours
Per
Year

10

60

Track & Field

Ran for the Varsity track and field team

12

This worksheet is adapted from the Activities and Awards Worksheet portion of the application for admissions to the University of California.

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