Signature of the Principal or designee indicates that the student has presented an appropriate outline. for meeting the
BREVARD PUBLIC SCHOOLS COMMUNITY SERVICE PROPOSAL BRIGHT FUTURES SCHOLARSHIP STUDENT NAME _______________________________ YEAR OF GRADUATION __________ SCHOOL:
Cocoa Beach Jr/Sr High School
(5011)
Please write legibly in PEN and use complete sentences. 1. Community problem/concern to be addressed: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 2. Reason for choosing this problem/concern: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. What will you do to have a positive impact on this problem or concern? How will your service hours positively affect the problem or concern? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 4. Name of agency (or agencies) where community service is to be performed: ____________________________________________________________________________ ____________________________________________________________________________ 5. Type(s) of service to be performed: ____________________________________________________________________________ ____________________________________________________________________________ 6. Method of self-evaluation of service learning experience: Along with my 100 HOURS (FAS) OR 75 HOURS (FMS) of community service, I will submit a twopage, 12 font, typed double space essay on what I learned from my volunteering experience.
I understand that this proposal to participate in community service is entirely voluntary on my part and that the completion of 100 HOURS (FAS) OR 75 HOURS (FMS) of documented community service related to this proposal can be used to satisfy the community service requirement of the Florida Academic Scholars’ Award. Selection of the problem to be investigated, development and implementation of a plan to investigate the problem, selection of an agency (or agencies), documentation of services performed, and evaluation of the community service project is the responsibility of the student. Signature of the parent indicates review and approval of this proposal and its activities. Transportation to and from outside agencies is the responsibility of the parent. Signature of the Principal or designee indicates that the student has presented an appropriate outline for meeting the community service requirement of the Florida Academic Scholars’ Award.
Student’s Signature __________________________________________ Date _________________ Parent’s Signature ___________________________________________ Date _________________ Principal’s Signature _________________________________________ Date _________________
