Please complete the following form and submit it to your U.S. History I teacher when you have decided upon your Service Learning Project. All forms should be submitted by February 1, 2007.

Name: _______________________________________________________

U.S. History I Teacher/Period: ____________________________________

Description of your Service Learning Project: ________________________

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Signature of Student: ___________________________________________

Signature of U.S. I Teacher: ______________________________________

Signature of Supervisor of Social Studies: ___________________________

(Ms. Podbelski's office is located in Room L400)