Service Learning Placement Form

Credit-Based Service Learning Placement Iform (including Service Learning, Student Aide):

1.

*

First Name

2.

*

Last Name

3.

*

School

Eisenhower

West

4.

*

Counselor

Mr. Annoye (Ike A-H)

Ms. Mees (Ike I-P)

Ms. Lohse (Ike Q-Z)

Ms. Weeks-Douglas (West A-He)

Ms. Landry (West Hf-P)

Ms. Fure (West Q-Z)

5.

*

Grade

9th

10th

11th

12th

6.

*

Your Email Address

7.

*

Your Phone Number

8.

*

Please select the volunteer course you registered for to earn credit (0.5 credit per semester, up to 1.0 full credit during high school career).

Service Learning (outside of school placement)

Student Aide (in school placement)

STUDENT AIDES

9.

Student Aide Location (what room number)

10.

Supervisor's Name

11.

Which semester(s) will you serve as a student aide?

12.

Which period(s) of day will you serve as an aide?

I am not a Robot

School District of New Berlin

Created with CMS4Schools

School District of New Berlin

4333 S. Sunnyslope Road, New Berlin, WI 53151
Phone: (262) 789-6200
Fax: (262) 786-0512
Nondiscrimination Notice / Disclaimers