2018
Senior Service
Internship Program

Rules and Regulations:
1.	Students must work a minimum of 4 hours daily, Monday thru Friday, excluding lunch
2.	Students who will be absent must notify their supervisor no later than 8:30 a.m. the day of the absence
3.	Students must maintain daily time sheets
4.	Students are not permitted in the high school or on other district school grounds unless assigned there or under the direct supervision of a THS staff member.
5.	Students must adhere to the code of conduct and the other rules and regulations stated in the THS Student/Parent handbook
6.	Students failing to comply with the above will be removed from Senior Service and returned to their regularly scheduled classes

Please return the following to Mr. Clark no later than Friday, May 4:
1.	Student information/Contract of Participation
2.	Senior Service Assignment Form/Supervisor Contract

The following must be returned to your guidance counselor by Friday, May 4:

1.	Sign out sheet
2.	Exemption sheet/Final Grade
3.	College Information Sheet

**Students must return to school to take AP Exams.**

Student and Parent Participation Contract
I have read and thoroughly understand the rules, requirements and expectations for participation in the Teaneck High School Senior Service Internship program and agree to abide by these rules.
I further understand that failure to comply with the above may result in the following consequences:
●	Immediate removal from the program and return to regularly scheduled classes
●	Ineligibility for exemption from final exams
●	Other penalties as stated in the Student/Parent Handbook
Student Name (Print): _________________________________________________________
Student Signature: ___________________________________________________________
Parent/Guardian Name (Print): ___________________________________________________
Parent/Guardian Signature: _____________________________________________________
Date: ________________

Student Information
(To be Completed by Student)
Student E-mail address: ________________________________________________________

Cell Phone: _____________________________ Home Phone: __________________________
Parent/Guardian: _____________________________________________________________
Parent/Guardian E-Mail address: ________________________________________________
Cell Phone: _________________________ Work Phone: __________________________

Teaneck High School

Senior Service Internship Assignment Form/Supervisor Contract

Student Name

	Guidance Counselor	
Name of Organization	Address of Organization

Name of Supervisor	Office Phone

Email Address		

Please complete this form and return to Mr. Clark no later than 
Friday, May 4th, 2018.

2018 Senior Service Internship Program Appeal Form:

Student Name: ________________________________________

Guidance Counselor: _________________________________

●	Type and attach the reasons why you feel you should be allowed to participate in the Senior Service Internship Program
●	Once completed, return this form and your statement to Mrs. Todman-Mack no later than Monday, May 7th, 2018.

Administrator:
__________________________________________
Margot Todman-Mack, Assistant Principal, 12th Grade: 

Approved: ________________		Not Approved: ______________________
Date: ________________

Student Sign-Out Senior Service:
To: 	Senior Class Teachers
___________________________________ has met the standards established for senior exemption in the following categories:
●	Senior year GPA of 3.0 or better and a minimum average grade of 2.0 in every class.
●	Attendance in compliance with state guidelines for eligibility
●	Completion of 60 hours of community service by Friday, April 27, 2018.
By signing below, you acknowledge and agree that the student has completed all course requirements and should be exempt from your final exam.

Period	Teacher	Final Grade	Teacher Signature	
0 – Health				
0 – Drivers Ed				
1				
2				
3				
4				
5				
6				
7				
8				
Community Service
*See Guidance Counselor 			Counselor Signature:

Library Obligations
*See Ms. Stack	Return library books and payment of outstanding Fines 		Ms. Stack Signature:	

Please complete this form and return to your guidance counselor no later than Friday, May 4, 2018 
Administrator Approval:
____________________________	___________________________________
Mrs. Margot Todman-Mack			Date

Office of the Assistant Principal
Teaneck High School
College admissions results and Scholarship Information
Return to Guidance

Guidance Department Senior Sign Out
Dear Seniors:
With only a few weeks remaining until graduation, there is still work to do!

The guidance department requires that you complete the College Admissions Results and Scholarship information in this letter Before you sign out for Senior Service and or Graduation.

You are required to report all college decision notifications.

The information will be used to verify where to send your final transcript and report class statistics.

The Form will be collected by your guidance counselor before they sign your Senior Service Permission form or certify graduation.

All forms must be returned to your counselor by Friday, May 4, 2018

Best wishes to each of you!

Student Name: ________________________________________________________

Guidance Counselor: ____________________________________________________

College you are attending: ________________________________________________

College Address: ______________________________________________________

****Give this sheet to Guidance by, Friday, May 4th!!****
List All of the colleges that you applied to:
Indicate result in last column
Accepted=A, Wait-Listed=W, Denied=D, Deferred=DF, No Response from School=NR for each school listed.

College	Early Action	Early Decision	Rolling	Regular Decision	Indicate Result A/W/D/DF/NR	

						

						

						

						

Scholarships Offered: indicate type – academic, athletic, other, name and amount

Name of Scholarship	Type of Scholarship	Amount per Year	Number of Years	Total	

					

					

					

Student Performance Evaluation

Student Name: ________________________________________________________

Site: _______________________________________________________________

Supervisor: __________________________________________________________

Thank you for participating in the Teaneck High School 2018 Senior Service Internship Program. We would appreciate it if you would complete this evaluation and give it to the student in a signed and sealed envelope.

Using the scale below, please circle the student’s performance in each of the following categories:
1=Unsatisfactory					4=Above Average
2=Below Average					5=Excellent
3=Average

Attitude						1  2  3  4  5
Compliance with Site Rules				1  2  3  4  5
Cooperation						1  2  3  4  5
Motivation						1  2  3  4  5
Completion of assigned tasks			1  2  3  4  5

Where was the student most effective? ______________________________________________________________________________________________________________________________________

In which categories was the student in most need of improvement?
______________________________________________________________________________________________________________________________________

Based on this experience, will you participate in future Senior Service Internship Program?  Yes__________			No___________
_____________________	__________________	_____________
Signature				Position/Title			Date

Please complete this form and return to Mr. Clark no later than Monday, June 18th, 2018.						
TIME SHEET:

Date	Time In	Time Out	Total Hours	Reason for Absence	
5-14-2018					
5-15-2018					
5-16-2018					
5-17-2018					
5-18-2018					
5-21-2018					
5-22-2018					
5-23-2018					
5-24-2018					
5-25-2018					
Memorial Day	XXXXXXX	XXXXXXXX	XXXXXXXXXX	XXXXXXXXXXXXXX	
5-29-2018					
5-30-2018					
5-31-2018					
6-1-2018					
6-4-2018					
6-5-2018					
6-6-2018					
6-7-2018					
6-8-2018					
6-11-2018					
6-12-2018					
6-13-2018					
6-14-2018					
6-15-2018					

Supervisors Signature: __________________________________________________

Date: _______________________________________________________________