Pinedale Elementary Outside Involvement Form Block “P” Award |

Petition for Point: Outside Involvement for Spirit or Body  Community Service Organization
 Community Athletics

_______________________ School Year

_______________________ Teacher

I, _____________________________, hereby request that 1 point be granted toward the Block “P” Award in the following category:

Body or Spirit (circle one)

for my participation in ________________________________________________. Name of organization

My advisor in this organization has judged my participation to be satisfactory and in keeping with the spirit of the Pinedale Elementary Code of Participation as certified by his/her signature below. This activity meets the criteria for this category as indicated in A Guide For Earning the Block “P” Award.

Description of Activity | Date of Activity

_________________________________ Student Signature

_________________________________ Parent Signature

________________ Date

________________ Date

Advisor’s Certification

I certify that _________________________________ is a member of our organization and has participated in a consistent and acceptable manner. I recommend that he/she be granted point toward the Pinedale Elementary Block “P” Award for the current semester.

___________________________________________ Advisor’s Signature	Title

______________ Date

Revised 2/17/2021