For Office Use Only:
Parent/Guardian Approval form
Culminating Project Proposal Waived
Class of 2011 and Beyond Cleared
Statement of Integrity
Please attach: Proposal Approved
Parent/Guardian Approval for Community Advisor form Faculty Contact Signature
Statement of Integrity ______________________________
Student Name: Staff Mentor: Current Date:
High School: Graduating Year:
Community Advisor Information:
Advisor Name: Organization: Email:
Mailing Address: Phone:
1. What is the essential question of your Culminating Project? (An essential question is the over-arching
question that encompasses the learning that will occur in your project. It does not have a “yes” or “no”
answer; rather, it is broad and thoughtful.)
Use two (2) or more complete sentences in answering each question below.
2. Briefly describe your Culminating Project plan including fieldwork:
3. How will your Community Advisor’s expertise/qualifications/experience help you with your project?
4. What is the timeline for your project, when and where will your Culminating Project take place?
5. How will your project benefit and/or connect to the community? (Examples of community include: school,
local, regional, national, and international)
6. What is the new learning you will experience and why will this be a learning stretch for you?
7. How does this project match a passion or interest you have?
8. In addition to the required “Culminating Project Time Log” and “Community Advisor Final Observation Form",
what artifacts will you collect for your portfolio that will document your progress and culminating project field
Students must comply with the requirements found in Board Policy 4060 and Procedures 4060P “Distribution of
Written Materials” if they want to distribute or post information related to their Culminating Project. To review the
policy and procedures go to: http://www.bham.wednet.edu/district/boardpolicies.htm.
Student Name ________________________________________________________
Culminating Project Statement of Integrity
I understand that intellectual integrity is the cornerstone of being a self-directed learner.
While completing all parts of my Culminating Project, I understand that all work will be the result of my
own efforts, unless it is appropriate to give credit to sources or others who have contributed to my
I understand that my finished portfolio needs to represent the complete project as approved in my
proposal. Any significant changes to my project (significance being determined by my teacher mentor
and/or culminating project site coordinator) must be submitted in writing at least 30 days prior to the
portfolio due date. Revised projects need to be approved to ensure the revisions still meet the
requirements for a quality project that includes a learning stretch and a connection or benefit to the
I agree to present an honest account of all Culminating Project activities, including artifacts, records of
community advisor meetings and documentation of a minimum of 20 hours recorded on the time log.
I understand that falsifying any aspect of my work related to the Culminating Project will result in me
needing to submit completely new, verifiably original work in order to receive a Bellingham School
District high school diploma AND result in the loss of privilege to participate in commencement
Student Name ______________________________________
Student Signature Date
Teacher Mentor/C.P. Site Coordinator Signature Date
Culminating Project Stepping beyond the Classroom and into the Community
Parent/Guardian Approval for Community Advisor
Student Name Graduation Year
Student’s Culminating Project Topic
As part of the Culminating Project, your student is expected to work with a Community Advisor.
Your student has designated as his or her Community Advisor.
As the parent(s)/guardian(s), you are strongly urged to ensure/verify that the Community Advisor has the
necessary licensing/training/expertise for the activity your student has chosen. The District does not
certify and/or verify the qualifications of the person your son or daughter has chosen as a Community
The District requires all Community Advisors to have a criminal background check through “Screen
Now” prior to working with students. “Screen Now” is a firm that provides background checks for
industries and non-profit organizations. The District acknowledges that there may be circumstances in
which the parent or guardian may want to waive the criminal background check requirement because the
Community Advisor is well known to the parent or guardian (e.g. member of the family, close family
friend). In order to waive the criminal background check requirement, the parent/guardian must
check the appropriate box below prior to allowing the student to work in unsupervised situations
with the advisor.
PLEASE CHECK ONE OF THE FOLLOWING BOXES:
I/We understand that by checking this box, the Community Advisor will complete a Community
Advisor Background Check Form (to be supplied by the student) and the District will perform a
criminal background check for the Community Advisor.
I/We understand that by checking this box, I/we waive the district’s requirement for a criminal
background check. I take full responsibility for electing not to subject my child’s Community
Advisor to a criminal background check.
The District prohibits a student from undertaking any activity, which may place the student
and/or his or her Community Advisor at an unnecessary risk of harm or injury. No such activity will
knowingly be approved by the District.
The parent(s)/guardian(s) should assess whether his or her student’s Culminating Project places the
student and/or the student’s Community Advisor at an unnecessary risk of harm or injury. If
parent(s)/guardian(s) or the District concludes the proposed Culminating Project places the student
and/or the student’s Community Advisor at an unnecessary risk of injury, the District will not approve the
activity as the student’s Culminating Project.
The District highly recommends that the parent(s)/guardian(s) regularly visit the location where his or her
student and the Community Advisor are working. Phone number(s) needed to contact the Community
Advisor should be kept by the parent. The District provides no supervision of the student while he or
she is working with the community advisor.
Although the District may periodically check with the Community Advisor to determine if the student is
completing the project in a timely fashion, it is the responsibility of the parent(s)/ guardian(s) to ensure
that the Community Advisor is (1) providing their son or daughter with a safe environment, and
(2) following all necessary safety procedures.
Although the Community Advisor and/or the parent(s)/guardian(s) play an important role in guiding the
student through the project phase of the Culminating Project, the student alone is ultimately responsible for
completing the project and submitting all of the forms and assignments required of him or her. School staff
coordinating the Culminating Project will remind all seniors that this is to be their Culminating Project,
not their parent’s project or their Community Advisor’s project.
I/We understand the conditions and expectations of the project phase of the Culminating Project, and I/we
approve my/our student’s selection of a Community Advisor as stated above.
Signature Relationship to Student Date