North Mecklenburg High School 9th & 10th Grade CAS Reflection Form

Name: ______

Date the activity began and ended: ______

Total # of hours: ______

Attach your LOG of dates and hours to this form if it is an ongoing activity.

Please check all appropriate boxes and answer all questions before you submit this form.

q Creativity q Action q Service
What task did you undertake? / What did you hope to do for the community?
q I undertook a new challenge / q I extended an existing challenge
What did you learn as a result of undertaking this challenge?
q I worked with others. / q I worked by myself.
How did you or others in the community help you accomplish your goal?
q My actions helped a global issue / q My actions helped a local issue
Describe the impact you had on the community.
q I discovered a new strength / q I discovered a new way to improve my life
How will you continue what you started?
What learning outcomes did you achieve in your activity? How are they evident? (See outcomes on back)

Student Signature:______

Parent Signature: ______

TO BE COMPLETED BY ACTIVITY SUPERVISOR (an adult not related to the student)

Comments on student’s performance:

Activity Leader’s signature:______Date:______

Activity Leader’s name:______

Agency/Organization:______

Contact phone number/e-mail:______

*You should show evidence of ALL 8 outcomes over the course of your CAS experience this year. Not all outcomes will be evident in each experience.

Outcome 1: Increase their awareness of their strengths and areas for growth

They are able to see themselves as individuals with various skills and abilities, some more developed than others, and understand that they can make choices about how they wish to move forward.

Outcome 2: Undertaken new challenges

A new challenge may be an unfamiliar activity, or an extension to an existing one.

Outcome 3: Planned and initiated activities

Planning and initiation will often be in collaboration with others. It can be shown in activities that are part of larger projects, for example ongoing school activities in the local community, as well as in small student-led activities.

Outcome 4: Worked collaboratively with others

Collaboration can be shown in many activities, such as team sports, playing music in a band, or helping in a kindergarten.

Outcome 5: Shown perseverance and commitment on their activities

At a minimum, this implies attending regularly and accepting a share of the responsibility for dealing with problems that arise in the course of activities.

Outcome 6: Engaged with issues of global importance

Students may be involved in international projects but there are many global issues that can be acted upon locally or nationally (for example, environmental concerns, caring for the elderly).

Outcome 7: Considered the ethical implications of your actions

Ethical decisions arise in almost any CAS activity (for example, on the sports field, in musical composition, in relationships with others involved in service activities).

Outcome 8: Developed new skills

As with new challenges, new skills may by shown in activities that the students has not previously undertaken, or in increased expertise in an established area.