The Academy of International Studies at Independence High School

Service Learning Record Form Personal Information:

Student Name ID Class of

2017 2018 2019 2020

Activity Information:Activity Title Activity Location/ Date(s)

Activity Sponsor Total Hour(s)

Choose One:Local Focus—at least 80 hours requiredInternational Focus—at least 40 hours required

Personal Reflection:*What area(s) did this activity help you to grow?

Personal Outcome(s) (personal efficacy, personal identity, spiritual growth, moral development)Social Outcome(s) (social responsibility, greater inter-cultural understanding, leadership skills)

Career Development (integrate knowledge from classes, connections to the community)*Explain how this experience has helped you develop at the personal level:

The Academy of International Studies at Independence HS

1967 Patriot Dr. Charlotte, North Carolina 28227 980.343.6900 ✦ katie.willett@cms.k12.nc.us

Continued on the other side:

Academic and Global Competency Reflection* What area(s) did this activity help you to grow?

#1 Ability to collaborate effectively in diverse cultural situations (Collaborate Effectively)

#2 Capacity to analyze and evaluate global issues from multiple perspectives (Develop Multiple Perspectives)

#3 Understanding of how international systems are interconnected and interdependent (Understand interdependence of systems)

#4 Capability to make ethical decisions and responsible choices that contribute to the development of a more just, peaceful, and sustainable world (Ethical decisions)

#5 Ability to identify, define and solve problems using critical and creative thinking strategies (Think critically and creatively)

#6 “Literacy for the 21st Century”—Proficient in reading, writing, viewing, listening and speaking in English and in one or more world language

#7 Understanding of the complexity of global issues (Understanding Complexity)

#8 Ability to identify, evaluate and organize ongoing learning opportunities to live and work in a successful global society (Manage learning)

#9 The use of digital media and technology to access relevant and credible information from around the world to effectively communicate, synthesize and create new knowledge (Communicate effectively)

#10 Achievement of expertise by researching, understanding, and developing new knowledge about a world culture or internationally relevant issue (Achieve expertise)

#11 Capability to make health decisions that enhance physical, mental and emotional well-being to thrive within a global environment (Make healthy decisions)

The Academy of International Studies at Independence HS

1967 Patriot Dr. Charlotte, North Carolina 28227 980.343.6900 ✦ katie.willett@cms.k12.nc.us

Explain how this experience has helped you develop connections to your learning, construction of new knowledge and connection to the global competencies :

Sponsor Signature: _________________________________________________________

PLEASE RETURN TO AIS DIRECTOR, ROOM 413

Internal Use only: Date Recorded Inquiry Returned?

The Academy of International Studies at Independence HS

1967 Patriot Dr. Charlotte, North Carolina 28227 980.343.6900 ✦ katie.willett@cms.k12.nc.us