8/9/2019 Silver Cord Form Updated 5-4-2015

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2445 San Diego Rd  Jacksonville, FL 32207 (904) 346-5620

Douglas Anderson’s Service Recognition Program

Intent to Participate Form

Our mission at Douglas Anderson School of the Arts is to be the leading public arts high school in the nation.

With this committed pursuit, we also believe that leadership, citizenship and ethics should be a part of every

student’s learning eperience. As a service!learning school, Douglas Anderson along with the "ational #onor

Society has established a program to recognize all graduating seniors who complete over $%% hours of

community service during their high school career. &he "ational #onor Society provides seniors who complete

this program with a special silver cord to wear with their graduation gown and they are recognized in the

graduation program for their service.

'lease accept this as my letter of intent to apply for Douglas Anderson’s Service (ecognition program. &his

intent to participate form, along with all community service hours earned prior to October ), $%)* must be

turned in to +r. etsch, +r. (aeford, or +r. +ahan by -%%pm &hursday October ), $%)*.

'lease print information re/uested below.

First Name: Last Name:

Art Area: Number of hours earned to date including an! attached here":

Phone: #mail:

Student Agreement:

0 understand that the due date to apply for this program is $:%% pm& 'hursda! (ctober )& *%)+.I understand that all service hours earned prior to (ctober )& *%)+ that have not been submitted must be

attached to this letter,

0 understand that all hours must be pre!approved before service is completed. #ours can be pre!approved by

school counselors who will be available &uesday, Wednesday and &hursday during lunches at the counselor

corner table.

0 understand that 0 am responsible for my own service hours and all forms must be personally handed to the

following teachers +r. etsch, +r. +ahan, or +r. (aeford before or after school.

0 understand that the deadline to submit service hours, earned between October $, $%)* and +arch 1), $%)2, is

$:%%pm Frida!& April )& *%)-

 "ote Service hours for 3right 4utures can be submitted up until $:%% pm& .ednesda! /une )& *%)-.

0 understand and recognize all re/uirements and deadlines listed above to be eligible for Douglas Anderson’s

Service (ecognition program.

Student Signature Date

Parent01uardian Signature Date