CAS PROPOSAL
FORM
STUDENT’S NAME_____________________________________GRADE_____DATE______
PARENT’S
NAME_____________________________SIGNATURE_____________________
PROJECT SUPERVISOR’S
NAME___________________________SIGNATURE__________________
TITLE________________________NAME
OF ORGANIZATION________________________________
ADDRESS___________________________________________________PHONE___________________
Description of project and
your
involvement:_______________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
How will creativity be
incorporated into this project?_________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
How will action be
incorporated into this
project?____________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
How will service be
incorporated into this
project?___________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
What skills do you plan to
develop through your participation in this project?______________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Where will this activity take
place if different from the above
address?___________________________________________________
_________________________________________________________Total number of hours
expected?________________________
Academic Coach’s
Name_____________________________________Approval
Signature__________________________________
Date
Approved________________________________Comments_______________________________________________________
____________________________________________________________________________________________________________