Mcps Form 560 50 PDF Details

In the ever-evolving educational landscape of Montgomery County Public Schools (MCPS), the emphasis on fostering well-rounded, community-minded students is mirrored in initiatives like the Student Service Learning (SSL) programs. The MCPS Form 560-50, a critical document updated in August 2021, serves as a gateway for students seeking to engage in volunteer opportunities not already vetted or listed on the Montgomery County Volunteer Center (MCVC) website. This form allows students to propose service activities with registered nonprofit organizations that adhere to the strict guidelines established by MCPS for SSL. It requires detailed information about the intended service, including the nonprofit organization's compliance with MCPS guidelines, the nature of the service activity, and proposed service dates. Further ensuring a structured and rewarding service experience, the form mandates parent or guardian approval and subsequent review by school-based SSL coordinators. These coordinators verify the educational value of the proposed service activities against the Maryland Student Service-Learning Guidelines, ensuring that volunteer work aligns with the Seven Best Practices of Student Service Learning. The form not only facilitates a seamless approval process for student-initiated service learning but also underscores the district's commitment to developing civic responsibility and leadership qualities among students, setting clear expectations and safeguards for a meaningful engagement with the community.

Form NameMcps Form 560 50
Form Length2 pages
Fillable fields26
Avg. time to fill out5 min 46 sec
Other nameslegibly, INFORMATIONTo, PREAPPROVAL, Maryland

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MCPS Form 560-50

August 2021

Page 1 of 2

Individual Student Service Learning (SSL) Request


Office of Student and Family Support and Engagement

Student Leadership Office


Rockville, Maryland 20850

See Maryland Student Service-Learning Guidelines

STUDENT INSTRUCTIONS: This form is for students to pursue a Student Service Learning (SSL) opportunity that is not identified on the Montgomery County Volunteer Center (MCVC) website. The names of registered nonprofit organizations that have certified compliance with MCPS Guidelines

for SSL can be found on Students should be familiar with the Seven Best Practices of Student Service Learning www. Students should complete this form by typing into this interactive form, or print legibly in blue or black ink, obtain parent/guardian approval, and submit it to their school-based SSL coordinator at least 2 weeks prior to starting the SSL activity.

STUDENT FOLLOW UP (if activity meets MCPS Guidelines for SSL after review by the MCPS SSL coordinator—see MCPS guidelines at Documentation of all service is due to the school-based SSL coordinator must be completed on MCPS Form 560-51, Student Service Learning Activity Verification Form, by the recommended or REQUIRED dates below: (please note that all SSL hours are available on StudentVUE portal after they have been verified by the school-based SSL coordinator. In order for the SSL hours to be reflected on the student’s report card, the dates below must be met.)

Service completed during the summer—Recommended by Last Friday in September

Service completed during the summer and 1st semester—Recommended by First Friday in January

Service completed during the summer, 1st semester, and 2nd semester to be recognized for the Certificate of Meritorious Service (high school seniors) or the Superintendent’s SSL Award (middle school)—REQUIRED by First Friday in April

Service completed during the summer, 1st semester, and 2nd semester—REQUIRED by First Friday in June

ALL SSL Forms for service completed any time during the current school year, including the summer before the current school year, are REQUIRED to be submitted to the school SSL coordinator no later than the first Friday in June.

STUDENT INFORMATION—To be completed by the student at least 2 weeks prior to beginning the volunteer activity.

Student Name (Last, First, Middle)_____________________________________________________________ Student ID _________ Grade _____

School -- Choose One --First Period Teacher_____________________________________________


Parent/Guardian Name__________________________________________Phone: Home or Cell _____-_____-______  Other _____-_____-______

Name of registered nonprofit organization that is NOT listed as MCPS SSL (those nonprofit organizations who have certified compliance with MCPS Guidelines for SSL) on the MCVC website, and student is requesting to volunteer with:__________________________________________

Name of nonprofit supervisor:______________________________________________________________________________________________

Service activities to be done include (please provide a detailed description of the volunteer service/activity you will be doing with this organization):

Proposed dates of service:  From ____/____/_____  To  ____/____/_____. (Maximum 1 school year)

Student Signature_______________________________________________________________________________________Date ____/____/_____


This form must be completed and submitted to the school SSL coordinator PRIOR to the student beginning a volunteer opportunity for which SSL hours are desired with an organization that is not identified on the current list of nonprofit organizations that have certified compliance with Montgomery County Public Schools (MCPS) Guidelines for SSL. This list can be found on the MCVC website at Please allow 2 weeks for the SSL Coordinator to review this request. The following guidelines must be met by the registered nonprofit organization named on this form in order for the student noted on this form to participate in an SSL activity with this registered nonprofit organization.


Provide ongoing supervision for MCPS students either directly or through appropriately authorized designee(s).


Advise students of the need that will be addressed by this service, overall expectations, and safety information.

Activities for which

Door-to-door distribution or neighborhood canvasing of any kind;

MCPS students

• Service supervised by parent or relative;


• Service without sponsorship of an approved, registered nonprofit organization;


• Service of a religious nature where the chief purpose is to convert others to a particular religious or spiritual view and/or which denigrates the

religious or spiritual views of others.



• Service of a religious nature where the chief purpose is to help prepare and/or participate in the performance of a religious service or


religious education activity.


• Service supervised by an individual who is younger than 18 years of age;


• Service performed on private property or in a private residence/home (unless specifically approved by the MCPS SSL coordinator);


• Service that replaces a paid staff worker of the participating agency.


• Service resulting in financial or other compensation.

DISTRIBUTION: Copy 1/School-based Student Service-Learning Coordinator; Copy 2/Student

MCPS Form 560-50

Page 2 of 2



Maintain general liability insurance that covers MCPS student volunteers.

Meet the Maryland

• Meet a recognized need in the community.

Seven Best

• Achieve curricular objectives through service-learning.

Practices of

• Reflect throughout the service-learning experience.


Develop student responsibility.

Establish community partnerships.



• Plan ahead for service-learning.


• Equip students with knowledge and skills needed for service.


Maintain a log and verify student service on MCPS Form 560-51, Student Service Learning Activity Verification according to program timelines.

Awarding of Hours

Award one (1) SSL hour for every hour of service, not exceeding eight (8) hours within a 24-hour period.

Ethical Conduct

Build positive relationships with MCPS students to support learning and adhere to standards of professional practice, including but not limited to

with Students

Section 2 of the MCPS Employee Code of Conduct, available on the MCPS website:

Sex Offenders

Shall not knowingly employ a registered sex offender at the site where an MCPS student is placed.

Compliance with

Comply with labor laws including the Fair Labor Standards Act, 29 U.S.C. Chapter 8; and all other applicable federal, state, and local laws and

Applicable Laws

regulations. The Organization Supervisor shall be responsible for reviewing and assuring compliance with the following Board of Education policies and


MCPS regulations, available on the MCPS website at Board Policy ACA, Nondiscrimination, Equity,


and Cultural Proficiency; MCPS Regulation ACA-RA, Human Relations; Board Policy ACF, Sexual Harassment; Board Policy JHC, Child Abuse and Neglect;


and MCPS Regulation JHC-RA, Reporting and Investigating Child Abuse and Neglect, including but not limited to those that prohibit discrimination, verbal


abuse, threats, physical violence, or sexual harassment directed at others.


(Organizations are encouraged to complete the online training on Recognizing and Reporting Child Abuse and Neglect, available




Organization Name__________________________________________________Federal Employer Identification # __ __ - __ __ __ __ __ __ __

Address  Street_ ________________________________________________ City_______________________ State ____ Zip Code ____________

Phone _____-_____-______  Fax _____-_____-______  E-mail_____________________________________________________________________

Secular activities (activities that have no religious or spiritual basis) to be performed by student include (please provide a detailed description of the services/activities the student is expected to perform):

My signature below certifies and vertifies that:

I am 18 years old or older.

I agree to the MCPS Guidelines for SSL noted above.

I agree to supervise the student in the above activities in a public place.

Name (Print)___________________________________________________________________ Title______________________________________

Signature_______________________________________________________________________________________________ Date ____/____/_____

PARENT/GUARDIAN APPROVAL: My signature below verifies that:

I approve and accept full responsibility for my child’s participation in this SSL opportunity with this organization.

I know this request must be submitted to, and reviewed by, the MCPS SSL coordinator prior to my child beginning the activity.

I understand that the organization with which my child will be volunteering is not listed on the MCVC website, but has submitted certification of compliance with MCPS Guidelines for SSL.

Parent/Guardian Name (Print)__________________________________________ Signature__________________________Date ____/____/_____


oOrganization has certified compliance with MCPS SSL Guidelines as detailed above 

oOrganization has not certified compliance with MCPS Guidelines for SSL

o Other (explain) ______________________________________________________________________________________________________

Signature, Coordinator, Student Leadership and Volunteers_ __________________________________________________ Date ____/____/_____

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