Seattle Schools Service-Learning Form and Reflection
The purpose of service learning is for students to take what they learn in the classroom and apply it to real-
world problems in their communities. Students may earn Service-Learning hours by volunteering or
participating in activities which are relevant to their communities, schools, support career exploration, which
are unpaid and supervised by an adult at the organization. Students must complete the form and reflection.
Date: __________ Student Name: ___________________________________________ Grade Level: ________
Student ID #: ___________________ School: __________________________________ School Year: _________
Organization: ________________________________________________________________________________
Address: ______________________________________ City/State/Zip Code: _____________________________
Description of Service Activities: __________________________________________________________________
____________________________________________________________________________________________
Date of Service Hours of Service Supervisor Date of Service Hours of Service Supervisor
Signature Signature
Total Hours: _________________ Supervisor Signature _______________________________________________
I verify that I have completed the above documented service and understand that I must also complete the
refection requirement in order to fulfill the service-learning requirement for high school graduation.
__________________________________________________ _______________________
Student Signature Date
_________________________________________________ _______________________
Parent Signature Date
______________________ ____________________________________________________________
Phone Email Address
Seattle Schools Service-Learning Form and Reflection
The student should complete the following reflection in order to meet the service-learning hours
requirements.
1. Why is there a need for this kind of service? Why did you choose this service-learning project?
2. Does this issue affect all people the same way? Are some communities impacted more by this issue than
others? Why is that? How does this impact the way the organization offers its services?
3. How is what you are studying/learning in school helping you to understand the issue? How has what you are
learning at school helping you to address this community need?
4. What types of careers are involved in the organization you chose? Do any of these careers interest you?
5. How does this service-learning project connect to your High school and Beyond plan? The courses you might
take, you career interests, future, or college plans?
6. In what ways have you been personally impacted by this experience?