Friends Project Service Contract & Approval Form - Bishop O'Dowd ...

BISHOP O’DOWD HIGH SCHOOLCampus Ministry Office of Service LearningFriends Project Service Contract& Approval FormContract is due when you BEGIN your service project.Send to O’Dowd.Mail: O’Dowd Service Learning, 9500 Stearns Ave. Oakland, CA 94605; Fax: 510-638-3259; Email: gmoore@bishopodowd.org(Pre-Approved list found at www.bishopodowd.org, go to Campus Ministry> Service Learning> Soph. Friends Proj.)Note: Contact the on-site adult supervisor and schedule your service - THEN complete this information.Student Name: Year of Grad: 20Contact Info: (home) (cell) E-mail(s): Indicate the best way to contact you (Check the box next to the best method)Service Site (Agency, Program, School, etc.):Project dates: (approx. is ok) Date the project begins:# hrs intended:and ending month:Supervisor: (Adult who will supervise the student while on site):Supervisor’s Title/position: Phone: ext?This should be an adult who is aware of this requirement and the student should have already contacted them. This person does not need to bethe only adult with the student the whole time, but she or he should be aware of what and how the student is doing, and be able to give anevaluation and verify service hours.Parental/Guardian Consent:I have discussed this service placement with my child and give my permission for her/him to volunteer at the abovenamed agency, school, or program. I understand that transportation is NOT provided by the school, and I takeresponsibility for providing or arranging transportation to and from this service site.I understand that as a volunteer she/he may be required to complete volunteer paperwork, training and/or volunteerhours in excess of the Bishop O’Dowd requirement, if disclosed in advance, and I will support those agencyrequirements.Signature of Parent/GuardianPrinted NameStudent Agreement:I agree to serve as a volunteer at the above named agency, school, or program to the best of my abilities, to show upwhen scheduled, and to notify my on-site supervisor in the event of unavoidable absence. I understand that as avolunteer I may be required to complete volunteer paperwork, training and/or volunteer hours in excess of the BishopO’Dowd requirement, if disclosed in advance, and I agree to follow all volunteer requirements. I also agree to maintaina clear and consistent record of my volunteer hours that is accessible to my on-site supervisor.Signature of Student• If requesting approval of a new site, complete the entire back side. ■ Only front needed if site is on pre-approved list.• (Pre-Approved list at www.bishopodowd.org; go to Campus Ministry> Service Learning> Soph Friends Project.)FriendsContractApprovalForm (“Goldenrod Sheet”) Last saved: 5/19/2011

APPROVAL FORM:For a new Friends Project site – complete this side.~ approval is required if a site is not on the “Pre-Approved Service” list ~Pre-Approved list found at www.bishopodowd.org/campus_ministry/sl_sophomore.php; go to Campus Ministry> Service Learning> Sophomore Friends Project.Repeat Agency or Program Name here:Is this program associated with a different organization? No Yes & name:(for example, a summer camp might be run by a national organization or a church, etc.)Repeat supervisor’s name here:Supervisor Email:Webpage:Mailing or Site Address:City State ZipDoes the agency contact/program supervisor prefer correspondence by e-mail or by regular mail?(Please answer the following questions. Form continues on the back of this sheet. Use extra sheets or back if needed.)What is the purpose of the agency or program? (Why does this agency/program exist, what do they do, who dothey work with? If this is a trip, where will you be going (country, city or area) and what is the main goal of the trip?)Title:What specific activities will the volunteer be doing? Please be as specific as possible. If this is a “weeklong,” immersion, or overnight experience, please give a sample daily schedule.A key component of our program is the direct, face-to-face contact our students have with people they serve. YouMUST have this “hands on” contact and the opportunity to build a relationship with the people you are serving or thisprogram will not be approved.How will this be a challenging and new experience for you the student? What do you hope to learn?What sort of training and/or preparation will the student have before doing this volunteer work?Please attach any additional information which would help to explain this project or agency.Return this form to Mr. Greg Moore, Bishop O’Dowd Service Learning, 9500 Stearns Ave. Oakland, CA 94605~or~ email: gmoore@bishopodowd.org ~or~ Fax: 510-638-3259 (Phone: 510-553-8645)The student requesting must check back with Mr. Moore within 10 days to inquire about approval