Learning Los EDU 201, EDU 202, EDU 203 Participation Log: Complete (Combine) S ) omponents to equal 10 hot for each type of service listed bel or more. Be sure to attach specific additional documents requ + Community Service: Your Full Name (print): ‘Component in which the student works a volunteer ‘capacity at ery egacizaton that wil allow volunteers, nd that servos the betterment of school age ciléen—-Agency/Type of Service: ‘nthe community. This ager 08 In which ho ‘Sudont sles nd can obtain a ven lett of Date(s) parcipation o°centfit rom he rgarizaton’ Teadorship that cecuments tek paricipaton end Datefs) hours of erect once complete Date's) « Private School Service: Total Hours: “The eer must arange contact and obtain writen permission rom the schoo! acinstraion pr supervisor Name (print) Nisan, and mst have an officer ofthe schoo! manervicor Signatwe: Soecpecseteer pentane te prol orcs pore en te Supericor Phone: ena Supenisor ea + Organized Field Trip: Your CEN matctor maybe sbieto organize an education Agency/Type of Service: ‘based fil rip In wich ll mers ofthe class meet at rather locaton, instead of ltending class atthe reader Datole) ‘Senedd ne to oan arvice credit. tudes must fl ‘out CSN’ Field Trip Waiver and provide it to the instructor Dates smenaeasiianaiinnsai efor raving toa sponsored of-camous vert. rect DAtel®) ee pours and vriaton fr he experience wil deerinad by your nec. Total Hours: + Other Service ‘Supervisor Name (print) staaeaaectt “The student can design and present a unique service ‘Supervisor Signature: sc slelllnaiaa =emnonrrncemnreaen ime! brerad ecucatona exeene thane. ‘Supervisor Pho ‘The propose! must ban witing and agreed upon by the OSH student and CSN instuctr prior ocudaton of hus. ne Supervisor e-mail ‘Agency/Type of Service: ‘YOU MAY NOT st the school you chose for your Field Observation request, or ary other CCD schoo! aS Datel) the agency orth Sannce Learing Proposal. Win? Fist Gal te Onoun orFls Oxanation sindepedentot DAIS) the 10 hours gerving the communty atancther agency. Dates) cess iets net eect ‘Secondly, you have no idea what schoo you wi eventual be pacer a tis me. Last, your eventual cooperating Total Hours: teacher may not give you parison to stay on extra 10 hours beyond the requlemants of the Fisid Observation. ‘The 10 hours of Community Service is nat reiated tothe 10, ‘Supervisor Name (print): ¢@ ours of COSD Feld Oboowation, <2 DONCTstatcod Supervisor Signature: (ating any CCSD school to exk permission to volunteer Supervisor Phone: there. ‘Supervisor e-mail: Se