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File IEH-E2
Community Service Student-Initiated Project (SIP) Approval Form The Community Service Student-Initiated Project (SIP) Credit Option enables students who make a contribution to their community by volunteering for worthwhile causes or organizations, to obtain credit for the civic skills, knowledge, and attitudes obtained in the volunteer activity. The volunteering done by students participating in this SIP is not the responsibility of the school, School Division, or Manitoba Education but an opportunity made available to students to obtain credit for private activity -a process similar to obtaining credit for the Private Music Option where students provide documentation on their standing to the school following completion of the activity. Student Information: (to be completed by the Student) Student Name: ________________________________________________________________ School Attended: __________________________ School Address: ______________________ Telephone: _________________E-mail: _______________________ Fax: ________________ Community Organization/Group Name: ____________________________________________
Learning Outcomes Achieved: (to be completed by the Student) Civic knowledge, skills, and attitudes obtained during this volunteering activity: _____________ _________________________________________________________________________ _________________________________________________________________________ Remuneration (payment) is not permissible. I was paid ___/not paid ___ for the community service work. Commencement date: ____________________ Completion date: _______________________ Number of Hours of Volunteer Time: (minimum 55hrs - .5 credit, minimum 110hrs - 1 credit) ___ Community Service Information: (to be completed by Community Service Organization/Group)
Contact Person Name (please print): ______________________________________________ Contact Person Signature Approval/Verification (signature): ____________________________ Address: ____________________________________________________________________ Telephone: ____________________ E-mail: ____________________ Fax: _______________
Credit Approval: (to be completed by School) Community Service Credit Value: .5 or 1.0 Course Level: 11G 21G 31G 41G (Circle one only) (Circle one only)
Signature of Parent/Guardian/Ward: ____________________________ Date: _____________ Signature of Student: ________________________________________ Date: _____________ Signature of School Contact Person: ____________________________ Date: _____________
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