Name: _____________________________ Date: ___________ Term/Semester: _________

----CAS Activities Form

PLEASE USE ONLY ONE FORM PER ACTIVITY PER COMPONENT!
If your activity applies to more than one component of creativity, action, or service, please include that
information in your description, but remember hours can only count in one category.

Creativity Action Service Hours

Check One
_______

Description:
(What did you do?)

Increased their awareness of their Undertaken new challenges

own strengths and areas for growth

Planned and initiated activities Worked collaboratively with others

Learning Outcomes
(Note in box to assist
you with reflections) Shown perseverance and Engaged with issues of global
commitment in their activities importance

Considered the ethical implications of Developed new skills

their actions
Name: _____________________________ Date: ___________ Term/Semester: _________

Location:
(Where did this
activity take place?)

Name of
Supervisor:_________________________________________
Supervisor &
Position:____________________________________________
contact details:
Phone number:______________________________________

Email address:_______________________________________

Notes:
(Anything that you
might want or need
for your monthly
reflection)

Signature of CAS Supervisor:______________________________________________________

Date:_______________

Comments:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________