8/20/2019 Silver-Cord-Form Updated September 2015

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

Douglas Anderson’s Silver Cord

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 November 2, 20! must be

turned in to )r. *etsch or )r. (aeford by +%%pm &hursday November 2, 20!.

'lease print information re-uested below.

First Name" #ast Name"

Art Area" Number o$ %ours earned to date &including an' attac%ed %ere("

P%one" )mail"

Student Agreement: understand that the due date to apply for this program is *"00 pm, +%ursda' November 2, 20!.

I understand t%at all service %ours earned prior to November 2, 20! t%at %ave not been submitted must be

attac%ed to t%is letter

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.

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

following teachers )r. *etsch or )r. (aeford

understand that the deadline to submit service hours, earned between November -, 20! and .arc% -, 20/,

*"00pm Frida', April , 20/

 "ote Service hours for /right 0utures can be submitted up until *"00 pm, ednesda' 1une , 20/.

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

Service (ecognition program.

Student Signature Date

Parent3uardian Signature Date