CAS Form
CAS Form
CAS Form
Letterhead verification
For SERVICE activities only: What SOCIAL issue is being addressed through this service? (Social issues might include but
are not limited to the following: programs for the elderly, disabled, victims of abuse, or the impoverished; environmental preservation; community or national culture; youth education or mentoring; health care; animal rights; etc.)
Name of sponsoring organization and/or a brief description of the activity (A complete prospectus will be required for some activities) :
Parent Signature: School Representative Signature (an email pre-approval may be attached for summer activities): Date: Date:
Part Two: ACTIVITY LOG (Students may use this space to track their hours.
Date Starting Time Ending Time Duration
If an additional full page log is needed or a time sheet is provided by the activity supervisor, simply write see attached in box below.
Activity or Activities
30 minutes = .50
45 minutes = .75)
Activities completed under the supervision of non-HHS personnel require a separate note on letterhead detailing the activity, the dates and duration of the students participation, and the students level of commitment. Please note: IB stipulates that activity leaders must be adults--not a students peers or parents.
(Note: This section is provided for activity leaders affiliated with HHS.
Punctuality and Attendance: Effort and Commitment: Total Number of Participation Hours: The activity was completed (circle the desired response): Activity Leader's name: Satisfactorily Title: Unsatisfactorily
Activity Leader can be reached at: ___-_______-________ ext_____ or, ____-_____-__________ ext_______ Activity Leader's signature: Date:
PLEASE NOTE THE FOLLOWING CHANGES: In order to be eligible for 1st semester exam exemptions, seniors must complete at least 15 Creative, 15 Action, and 60 Service hours. (NOTE: 150 hrs are due by April 15th of your senior year for completion.) In order to be eligible for 2nd semester exam exemptions, juniors must complete at least 10 Creative, 10 Action, and 25 Service hours.
Student's Signature:
Date:
Part Five: HOMEROOM TEACHERS FINAL VERIFICATION (Note: The teachers signature verifies that all of the required
evidence is attached (letters, logs, evidence of creative product, etc.), that all portions of the CAS form (especially CAS category, total hours, self-evaluation essay) are complete and legible, and that the form was submitted within 30 days of the completion of the activity)
Date: