How to fill out your CAS Form

Report
How to fill out your CAS Form
(For Incoming IB Freshmen)
CAS Procedures
 Find an activity
 Complete Part 1:
 Get a blank CAS form
 Fill out the top portion
 Get your activity PRE-APPROVED (Have your
parent/guardian sign FIRST!)
CAS SELF-EVALUATION FORM
International Baccalaureate Programme
Strawberry Crest High School
____Pre-IB (9th & 10th)
____IB DP (11th & 12th)
Part One: Pre-approval
John Doe
1234567
2015
X
Type of Activity:
_____Creative _____Action
_____Service
Estimated Number of Hours: ___________
15
The
environment
FOR SERVICE ACTIVITIES ONLY: What SOCIAL ISSUE is being addressed? __________________________________________
Keep Hillsborough County Beautiful
Name of sponsoring organization:________________________________________________________________________
Student’s name: ___________________________________________ Student #________________ Class of: __________
Picking up trash at Lettuce Lake Park
To increase my understanding of the need for environmental
Goals/ Purpose of activity:______________________________________________________________________________
protection;
to
clean
up the park
___________________________________________________________________________________________________
Description of Activity: _________________________________________________________________________________
STUDENT MUST HAVE PRE-APPROVAL FROM A PARENT AND A MAGNET TEACHER PRIOR TO START OF ACTIVITY.
Mrs. Doe
Mrs. Smith
School Representative Signature: _____________________________________
Parent Signature: __________________________________________________
8/25/2011
8/26/2011
Date: ___________________
Date: ___________________
Part Two: Activity Log (Please use 15-minute increments for partial hours; use 0.25, 0.5, 0.75)
•Only one TYPE of activity
per form
•Estimation is OK
•Must have a goal
•PARENT/GUARDIAN signs
before HR teacher or Mrs.
Smith
 Example 1: Creative Activity
CAS SELF-EVALUATION FORM
International Baccalaureate Programme
Strawberry Crest High School
Part One: Pre-approval
John Doe
X
_____Creative
X
____Pre-IB (9th & 10th)
____IB DP (11th & 12th)
2015
25
Estimated Number of Hours: ___________
1234567
Student’s name: ___________________________________________ Student #________________ Class of: __________
Type of Activity:
_____Action
_____Service
FOR SERVICE ACTIVITIES ONLY: What SOCIAL ISSUE is being addressed? __________________________________________
SCHS Band
Performing at football games, practice
Description of Activity: _________________________________________________________________________________
To get better at playing the trumpet; to get a “superior” at
Goals/ Purpose of activity:______________________________________________________________________________
Solo & Ensemble this year
___________________________________________________________________________________________________
Name of sponsoring organization:________________________________________________________________________
STUDENT MUST HAVE PRE-APPROVAL FROM A PARENT AND A MAGNET TEACHER PRIOR TO START OF ACTIVITY.
Mrs. Doe
Parent Signature: __________________________________________________
Mrs. Ferrario
School Representative Signature: _____________________________________
8/25/2011
8/26/2011
Date: ___________________
Date: ___________________
 Example 2: Action Activity
CAS SELF-EVALUATION FORM
International Baccalaureate Programme
Strawberry Crest High School
Part One: Pre-approval
John Doe
____Pre-IB (9th & 10th)
____IB DP (11th & 12th)
2015
10
Estimated Number of Hours: ___________
1234567
Student’s name: ___________________________________________ Student #________________ Class of: __________
Type of Activity:
X
_____Creative _____Action
_____Service
FOR SERVICE ACTIVITIES ONLY: What SOCIAL ISSUE is being addressed? __________________________________________
Brandon Flames
Playing Soccer
Description of Activity: _________________________________________________________________________________
To be a better goalie- make more saves this season
Goals/ Purpose of activity:______________________________________________________________________________
Name of sponsoring organization:________________________________________________________________________
___________________________________________________________________________________________________
STUDENT MUST HAVE PRE-APPROVAL FROM A PARENT AND A MAGNET TEACHER PRIOR TO START OF ACTIVITY.
Mrs. Doe
Parent Signature: __________________________________________________
Mrs. Hofmann
School Representative Signature: _____________________________________
8/30/2011
9/1/2011
Date: ___________________
Date: ___________________
 Example 3: Service Activity
CAS SELF-EVALUATION FORM
International Baccalaureate Programme
Strawberry Crest High School
____Pre-IB (9th & 10th)
____IB DP (11th & 12th)
Part One: Pre-approval
John Doe
1234567
2015
25
X
Type of Activity:
_____Creative _____Action
_____Service
Estimated Number of Hours: ___________
FOR SERVICE ACTIVITIES ONLY: What SOCIAL ISSUE is being addressed? __________________________________________
Poverty
Metropolitan Ministries
Name of sponsoring organization:________________________________________________________________________
Feeding the hungry and sorting canned goods
Description of Activity: _________________________________________________________________________________
To help people in need; to increase my understanding of
Goals/ Purpose of activity:______________________________________________________________________________
people in poverty
___________________________________________________________________________________________________
Student’s name: ___________________________________________ Student #________________ Class of: __________
STUDENT MUST HAVE PRE-APPROVAL FROM A PARENT AND A MAGNET TEACHER PRIOR TO START OF ACTIVITY.
Mrs. Doe
Mr. Ward
School Representative Signature: _____________________________________
Parent Signature: __________________________________________________
10/28/2011
10/30/2011
Date: ___________________
Date: ___________________
CAS SELF-EVALUATION FORM
International Baccalaureate Programme
Strawberry Crest High School
____Pre-IB (9th & 10th)
____IB DP (11th & 12th)
Part One: Pre-approval
Student’s name: ___________________________________________ Student #________________ Class of: __________
 Complete Part 2:
 Complete your activity, and have the supervising
adult (not a parent or relative!) initial next to your
hours you logged, verifying you were there.
Type of Activity:
_____Creative _____Action
_____Service
Estimated Number of Hours: ___________
FOR SERVICE ACTIVITIES ONLY: What SOCIAL ISSUE is being addressed? __________________________________________
Name of sponsoring organization:________________________________________________________________________
Description of Activity: _________________________________________________________________________________
Goals/ Purpose of activity:______________________________________________________________________________
___________________________________________________________________________________________________
STUDENT MUST HAVE PRE-APPROVAL FROM A PARENT AND A MAGNET TEACHER PRIOR TO START OF ACTIVITY.
Parent Signature: __________________________________________________
Date: ___________________
School Representative Signature: _____________________________________
Date: ___________________
Part Two: Activity Log (Please use 15-minute increments for partial hours; use 0.25, 0.5, 0.75)
Date
8/31/11
9/1/11
9/2/11
9/3/11
9/3/11
Starting
Time
3:30 pm
3:30 pm
3:30 pm
3:30 pm
6:00 pm
Ending
Time
6:00 pm
6:00 pm
6:00 pm
6:00 pm
10:00 pm
14
TOTAL Hours Served: _________
Duration
2.5
2.5
2.5
2.5
4
Activity or Activities
band practice
band practice
band practice
band practice
football game
Circle one: C A S
Part Three: Evaluation (To be completed by activity leader)
Verified
Parent Signature: __________________________________________________
Date: ___________________
School Representative Signature: _____________________________________
Date: ___________________
Part Two: Activity Log (Please use 15-minute increments for partial hours; use 0.25, 0.5, 0.75)
Date
Starting
Time
Ending
Time
Duration
Activity or Activities
Verified
 Complete Part 3:
 Once the activity is completed, have the
supervising adult fill out the bottom portion of the
form, evaluating your work.
TOTAL Hours Served: _________
Circle one: C A S
Part Three: Evaluation (To be completed by activity leader)
Punctuality and attendance: ________________________________________________________________________
Effort and commitment: ____________________________________________________________________________
The activity was (circle the desired response):
Satisfactorily completed
Unsatisfactorily completed
Activity leader’s name and sponsoring organization: __________________________________________ (PLEASE PRINT)
Activity leader’s signature: _______________________________________
Pre IB: 50 Total Hours
25 Service Hours (Addressing no more than 3 social issues
from the Bright Futures District Guidelines)
10 Action Hours
10 Creative Hours
5 hours in any area
CONTINUE ON REVERSE
Updated 10/1/2010
Date: ________________
IB: 150 Total Hours
50 Service Hours (Addressing no more than 3 social issues
from the Bright Futures District Guidelines)
35 Action Hours
35 Creative Hours
30 hours in any area
*Must fulfill 8 Learning Outcomes
*CAS Project (30 hrs minimum)
 Complete part 4:
 Complete the BACK of the
CAS form
 Instructions are on Mrs.
Smith’s website
 Turn the form in to your
homeroom teacher so they
can complete Part 5.
SIDE 2
Part Four: Reflection and Self-evaluation
At the completion of the activity, reflect on your experience by using the following eight learning outcomes. Be sure to
include a pre-reflection. Below, please check off the learning outcome(s) that you addressed through your CAS activity. Be
able to describe in depth how you have achieved each learning outcome in your activity and describe not only what you
learned from your experience, but how this experience contributed to your personal growth. You are encouraged to include
aspects of the learner profile. Be able to provide evidence of some kind that clearly demonstrates personal growth. Discuss
any goals you set for yourself in this activity and be sure to address whether or not you achieved them and why. Your
writings should somewhat resemble a journal entry. If describing more than one outcome, please use separate paragraphs.
Clearly label by number each learning outcome described. You are also strongly encouraged to attach photographs, flyers,
certificates, letters, and any other form of evidence to help demonstrate what you learned and achieved. Note: All eight
learning outcomes must be achieved by the completion of the Diploma Programme.
Learning Outcomes
1.
2.
3.
4.
5.
6.
7.
8.
Achieved (√)
Date(s)
Increased my awareness of my own strengths and areas for growth
I have undertaken new challenges
I have planned and initiated activities
I have worked collaboratively with others
I have shown perseverance and commitment in my activities
I have engaged with issues of global importance
I have considered the ethical implications of my actions
I have developed new skills
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
I attest that I have upheld the Honor Code of the IB Program at Strawberry Crest High School and that that the hours being
submitted on this form are my own. I understand that breaches of the Honor Code may result in my not receiving the IB
Diploma. I will abide by the letter and spirit of the Strawberry Crest IB Honor Code.
Student’s signature: _______________________________________________________
Date: ______________
Part Five: Final verification
Homeroom Teacher’s Signature: _____________________________________________
Date: _______________

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