SHAWNEE MISSION NORTHWEST CAS HOUR FORM
Return with student or mail to: Bill Sanderson, Coordinator
Shawnee Mission Northwest High School
12701 W. 67th Street
Shawnee, Kansas 66216
Phone: 993-7363
NAME:___________________________________DATE:___________
1. Brief description of CAS project to be completed: CAS process:
(include what it is, what you hope to learn about yourself 1. Get project approved
and how this activity will influence your life) (Sanderson signs form
or you email him and
wait for return email)
2. Fill out form describing
process, get signatures,
list C A or S and hours.
3. Fill in reflection section
4. Turn into Mr. Sanderson
Number of hours total:___
How counted? Creativity_Action__Service___
2. IB Coordinator’s signature indicating approval of project (done before
starting)
________________________________________DATE:_________
Coordinator signature
Form (ATTACH SANDERSON’S APPROVAL EMAIL TO THIS FORM IF DONE
continues DURING SUMMER OR OTHER BREAKS)
on the
Supervisor’ section: Please comment on the student’s performance on
back of
this sheet the activity you supervised. What observations do you have regarding
how they completed the task(s)?You may return this form with the
student or mail it to Bill Sanderson at the address at the top of the page.
You will be contacted personally to verify your statements. Attach
separate sheet if needed.
__________________________________________DATE:_________
Supervisor signature Supervisor phone number:_____________
3. Student reflection: Write 3-4 paragraphs below reflecting on the activity.
Was it rewarding? What did you learn? Would you recommend it to a
friend? Did completing the activity enrich you as a person? How? MAKE
SURE YOU LOG THE ACTIVITY IN YOUR CAS DIARY AND
WRITE A SHORT REFLECTION THERE AS WELL. The diary is due
with your final CAS essay in March of your senior year.
4. Student signature: By signing and dating this form, I pledge that the
activity was completed according to CAS guidelines and that my
reflection above represents an honest appraisal of what I learned in the
experience.
____________________________________Date of Activity___________
Student signature