Dear Sir/Madam,

This student is currently studying in the Middle Year Program (MYP) at Beijing World Youth Academy (BWYA). In order
to successfully complete this program they are required to complete a variety of Service as Action (SA) experiences. Each SA
experience requires them to plan, take part in, and reflect upon their participation within the service based experience.

To help the student make the most of the experiences it is beneficial for them to have a supervisor who can guide and mentor
them. Someone who can assist them in the pursuit of the goals they have set and someone who can verify and confirm their
satisfactory participation in the experience by completing a short supervisor review form. Please feel free to ask the student to
explain more about the requirements of SA, if required, and feel free to contact us if you have any further questions or
concerns about the student or the program.

Responsibilities – SA supervisors should:

• be familiar with elements of the program they are supervising

• be responsible for student safety and risk management procedures
• provide students with guidance, support and feedback on the SA experience
• encourage reflection
• comment on the student’s engagement with the SA experience through the form of a supervisor review.

Below you will find a document we would like you to complete on the first day our student starts their experience. This in
order for us to verify that every student has an appropriate supervisor.
Please feel free to contact me via email at duxiaoyi@ibwya.net should you have any questions, queries or concerns.

Kind Regards,

Lisa Du
G9-10 Service as Action Coordinator
 Supervisor Agreement Form
Attention students: Please note that before any hours can be logged and reflected upon for this
experience, your supervisor form must first be uploaded to your experience page in ManageBac.

Student's Full name:

Experience name:

Estimated total hours of SA experience:

Supervisor's full name:

Supervisors email address:

Supervisors contact number:

Attention Supervisors:

Before you sign the form to acknowledge acting as a SA supervisor please be aware of the following points:

• I have read, understood, and agreed to the SA responsibilities of the supervisor.

• I acknowledge that I am neither a family member nor a personal friend to the student. I am at least 18 years of age.
• I agree not to provide monetary compensation (gifts or money) in exchange for the services students may provide.
• I will complete the student’s “Volunteer Verification form” or provide some other form of attendance tracking for
the student during this experience.
• I agree to complete a brief review at the end of the student's experience.
This review will be requested by the student via email at the end of the experience.

Supervisor signature:

Date: