Community Service Credit Forms
Community Service Credit Forms
I have discussed the Community Service SIP credit option with my son/daughter/ward and support his or her
participation in this credit option in the following community service activity.
I am aware:
that participation by a student in a CSSIP activity may, but will not necessarily, be recognized by the school for credit,
and that whether a credit will be recognized and the level of credit that will be recognized will be based on the civic
knowledge, skills, and attitudes that are obtained by the student in the activity, which will be evaluated and
confirmed by the school based on the student’s participation and completion of the activity
that a maximum of one (1) community service credit can be earned, which can be used towards the total number of
credits required for graduation
that participation by a student in a community service activity prior to him or her obtaining permission from the
school to proceed with the activity cannot be applied towards a CSSIP credit
that a community service activity will not be recognized for a CSSIP credit where the activity involves assisting
immediate family members
that in order for a community service activity to be recognized for a CSSIP credit, no payment(s) can be accepted by
the student
that court-imposed community service cannot be used for the CSSIP credit
that participation by a student in a community service activity for a CSSIP credit is a private activity outside the
regular school program
that a student who participates in a community service activity for a CSSIP credit option is not enrolled in a course
nor is he or she performing work that is part of a course that is approved by Manitoba Education, and is not engaging
in a work education program nor participating in a program conducted off the school premises under the authority of
a school board
that in evaluating the community service activity prior to the start of the activity by the student, the school will
evaluate only the civic knowledge, skills, and attitudes to be obtained by the student in the activity and will not
evaluate any hazards that may be associated with the CSSIP activity
that neither the school, nor the school division, nor Manitoba Education will be liable for any injury to the student or
for any damage to or loss of property of the student caused by or in any way related to the student’s participation in
a CSSIP activity
that a student and his or her parents/guardians bear the responsibility for the student’s safety. A student should
discuss concerns about the nature of the community service activity with his or her parents/guardians and, together,
they should exercise discretion, be aware of safety issues, and investigate the community organization’s or group’s
liability insurance coverage for volunteers before deciding that the student will participate in the CSSIP activity
that a student may withdraw from the community service activity at any time for any reason, including for the reason
that the CSSIP activity workplace conditions are not acceptable to the student or to their parents/guardians.
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School Address: _139 Northlands Parkway East, Winkler, MB, R6W 0E9_ Telephone: _204-325-8200__________
STUDENTS ARE EXPECTED TO KEEP A DETAILED RECORD OF DAYS/HOURS VOLUNTEERED WITH ORGANIZATION. THIS
RECORD SHOULD BE SUBMITTED, ALONG WITH LETTER FROM ORGANIZATION, BEFORE CREDIT WILL BE GRANTED.
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CREDIT APPROVAL (to be completed by school after volunteer service and hours confirmed with a letter received from
organization where volunteer hours were completed, along with student’s detailed record of days/hours served.)
Number of Hours Completed: __________ (note: minimum 55 hrs for 0.5 credit; 110 hrs for a maximum 1.0 credit)
Community Service Credit Value (circle one): 0.5 OR 1.0 Course Level (circle one): 11G 21G 31G 41G