Student Presenter Registration Form

Course

Instructor

Group Leader
Student 1 Name / Student 1 ID# / Student 1 Phone / Student 1 Email / Student 1 T-Shirt Size (Sizes XS - 3XL available)
XS SM M L XL 2XL 3XL

Student 2 Name / Student 2 ID# / Student 2 Phone / Student 2 Email / Student 2 T-Shirt Size (Sizes XS - 3XL available)
XS SM M L XL 2XL 3XL

Student 3 Name / Student 3 ID# / Student 3 Phone / Student 3 Email / Student 3 T-Shirt Size (Sizes XS - 3XL available)
XS SM M L XL 2XL 3XL

Student 4 Name / Student 4 ID# / Student 4 Phone / Student 4 Email / Student 4 T-Shirt Size (Sizes XS - 3XL available)
XS SM M L XL 2XL 3XL

Name of Activity

The activity is best suited for what grade/age?

Brief description of Activity

What will the children do? (If they are only observing, the plan will NOT be approved.)

What do you want the children to learn from their participation?

Are you prepared to explain scientific concepts, literary theme, culture, or techniques using age-appropriate language?
YesNo

The Service Learning Program will provide T-shirts for each student presenter. If you have questions or need assistance with your projects, please contact the Service Learning Center at 760.795.6616 or servicelearning@miracosta.edu.