NOTIFICATION OF PLANNED COMMUNITY INVOLVEMENT ACTIVITIES Student Name
Principal
Mr. M. Searson School Name
Telephone Number
St. Joseph’s Catholic High School
613-432-5846
Please provide the information requested below about the community involvement activities in which you plan to participate. Estimated Number Of Hours
Name of Charity, Parish, Community Service Club, etc. and Description of Activity
Estimated Date of Completion
***Is each activity identified on the school board’s list of approved activities?
Location of Activity and Phone No.
Yes
Supervisor’s Name (Please Print)
Signature of Approval (Principal, Counsellor)
No
If you checked “No”, you must obtain written approval from the principal (the principal’s signature above) before starting the activity.
Student’s Signature
Date
Parent’s or Guardian’s Signature
In accordance with the Municipal Freedom of Information and Protection of Privacy Act, all personal information collected under the authority of the Education Act is intended to be used to determine eligibility for selection and participation in the Community Involvement Activities Program, which is required for an Ontario Secondary School Diploma.
Date