Dear applicant,

Please take this form to each of your teachers and have them fill out the Grade Point and Recommendation parts of the form.Then fill out the bottom portion for your Community Involvement and have the adult supervisor from that activity sign it.You must return this form to the Renaissance Stamping table in the QUAD during lunch no later than Friday January 29th.Forms turned in after that date before the Renaissance Assembly will not be accepted.

 

CLASS/TEACHER

Please
Circle

GRADE
POINT
NO D or F

LIFE LONG LEARNING SKILLS
CITIZENSHIP & WORK HABITS

RECOMMENDATION
(NO Nís or Uís or less than 2ís)

Language Arts

43

2

NO N/U in CIT/Work HabitsAt least a 2 in LLL

 

Teacher Initials:___________________________

Math

43

2

NO N/U in CIT/Work HabitsAt least a 2 in LLL

 

Teacher Initials:___________________________

Science

43

2

NO N/U in CIT/Work HabitsAt least a 2 in LLL

 

Teacher Initials:___________________________

History

43

2

NO N/U in CIT/Work HabitsAt least a 2 in LLL

 

Teacher Initials:___________________________

PE

43

2

NO N/U in CIT/Work HabitsAt least a 2 in LLL

 

Teacher Initials:___________________________

Elective A*

43

2

NO N/U in CIT/Work HabitsAt least a 2 in LLL

 

Teacher Initials:___________________________

Elective B*

43

2

NO N/U in CIT/Work HabitsAt least a 2 in LLL

 

Teacher Initials:___________________________

TOTAL

(To be entered at Renaissance Stamping by the PTSAStampers)

 

 

 

GOLD=24-22

SILVER=21-16

BRONZE 12-15

Highest Score will be used

COMMUNITY INVOLVMENT FORM

YOUR NAME:_________________________________________________________________

NAME OF ACTIVITY:____________________________________________________________

DATES OF INVOLVMENT________________________________________________________

ADULT SUPERVISOR SIGNATURE:________________________________________________

 

DATE TURNED IN:____________________________________________________________