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Washougal High School
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Participation requirements:
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Submit materials to:
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Questions?
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Washougal High School
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Intent to Participate
Submit to W HS Career Center beginning Monday after Spring Break
for award period ending the next school year.
First Name:
Last Name:
Current School:
Expected Graduation Year:
Grade:
Mailing Address:
Phone :(
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City:
Zip:
Email:
(ALL NOTIFICATIONS W ILL BE SENT TO THIS ADDRESS)
REQUIREMENTS
Be a student in grades 9 -12 at Washougal High School or Excelsior High School. Home-schooled students affiliated with
Washougal School District are also eligible to apply.
Complete at least 150 hours of community service beginning the Monday after Spring Break until the Friday before Spring
Break the following school year. If you have already completed service within those dates before you sign up, YOU CAN
STILL COUNT IT as long as you can document it accurately and provide your supervisor's contact information.
At least 50 of your 150 (or more) hours MUST be in a non-school related activity unaffiliated with your high school (i.e.,
community organization, church group, Boy Scouts, etc)
You must have at least one school-related volunteer activity (i.e., ASB, Star Mentor, tutoring, concessions etc). There is
no hour requirement for this.
Your Intent to Participate form must be submitted upon decision to participate.
You must submit your Community Service Verification forms for each service opportunity/group with the application.
Your application must be RECEIVED by the Friday before Spring Break.
Student Agreement:
I understand all requirements of the WHS Community Service Varsity Letter program. I understand that all of my volunteer
work must be competed between the beginning of Spring Break and the end of Spring Break the following school year. All
hours must be documented in completed verification forms and meet all the qualifications as outlined in the WHS
Community Service Varsity Letter Guidelines.
Student Signature:
Date:
Please don!t hesitate to contact the W HS Career Center with any questions about your volunteer
work and how to count it at: sharon.watts@washougalsd.org or 360-954-3119.
Washougal High School
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APPLICATION CHECK LIST
"!!II have submitted an Intent to Participate form with my signature and contact
information.
"!!II have included the student information page of the application with my signature and
the signature of my parent/guardian.
"!!II have included verification forms documenting all of my volunteer work that I!d like
verified and included for this award and am confident all of my hours qualify.
"!!II have made a copy of my application for my future reference.
"!!II have at least one school-related volunteer activity and at least 50 of my total hours are
with non-school related activities.
"!!M
My application will be received at the W HS Career Center by Friday before Spring
Break.
"!!II have purchased a WHS ASB card.
Please don!t hesitate to contact the WHS Career Center with any questions about
your volunteer work and how to count it at: sharon.watts@washougalsd.org or
360-954-3119.
Washougal High School
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APPLICATION ! Student Information
Deadline: Friday before Spring Break
First Name:
Last Name:
Expected Graduation Year:
Mailing Address:
Phone :(
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City:
Zip:
Email:
(ALL NOTIFICATIONS W ILL BE SENT TO THIS ADDRESS)
ATTENTION SENIORS: You may qualify for a number of scholarships as a result of your volunteer service.
Visit http://www.washougal.k12.wa.us/whs/departments/careercenter.htm for more information.
Years Awarded
Please circle one:
This is my: 1st 2nd 3rd 4th
Varsity Letter in Community Service
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ASB Card:
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How many hours did you volunteer?
______ Total served through school-related
activities- 50 hours maximum ]&*$6(&2*$3)($
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+ ______Total served outside of school related
activities ]&*$6(&2*$+--$034'2^
= _______Total number of hours served. (Must be
at least 150)
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Student Agreement:
I attest that I performed the documented hours of community service included in the attached verification forms and met all the
qualifications as outlined the WHS Community Service Varsity Letter Guidelines. To my knowledge, these hours are valid and count
toward my earning the Community Service Varsity Letter.
Student Signature:
Date:
Parent/Guardian Agreement:
I hereby assign to the Washougal High School Career Center all rights to video and audio recordings and all photographs of my child
made in connection with the Community Service Varsity Letter activities.
Parent/Guardian Name:
Parent/Guardian Signature:
Date:
012345617!8963!%:3447!
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Deadline: Friday before Spring Break
Copies of this form must be completed for each agency/organization/school/club for which you have
performed service. Only one form is needed per supervisor for total hours spent with that supervisor.
You will only receive credit for the number of qualifying hours we are able to verify.
Student Name:
Number of hours to verify:
Organization, club or school name that you volunteered with:
This opportunity is:
"!School related
"!Non-school related (outside of school activities)
When did you volunteer? Only include hours within program year guidelines.
"!Ongoing Volunteering:
"!One-time volunteer:
Please list time frame
Please list specific date
Brief description of volunteer work you performed:
VERIFICATION CONTACT INFORMATION (Please PRINT all information clearly)
Please provide as much contact information as your supervisor allows. Be sure to tell them that a WHS staff
member may be contacting them in April to verify your hours. We recommend including multiple contact
methods to ensure we are able to fully process your application.
Adult Supervisor:
Organization:
Title:
Email:
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Work Phone:
Cell Phone:
Home Phone:
Best time/method to be contacted:
*If your supervisor !"#$%&'()*)(&+"&,-'.//&+01/&'("2)//3&+0)-&2.4&516)&-"#&.&/154)%&$)++)(&"4&+0)1(&"(5.417.+1"48/&$)++)(0).%&/+.+145&-"#(&6"$#4+eer efforts to be
included in your application. This letter must include all information requested on the verification form.
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This page is optional and only supplied to help you track your hours.
This form does not need to be turned in with the rest of your application. It is intended to help you track
your volunteer hours and may be duplicated as needed. An example is included in the first line. All of
your service hours must occur between the Monday after Spring Break and the Friday before
Spring Break the following year.
Student Name
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