Student LAST name:______FIRST name:______
The entire application that follows is due by February 1st, 2017.
You will complete some parts before others.
When your proposal is complete, make three (3)copies of the completed proposal. That’s a total of four (4).
Turn in the original and two (2) copies to Mr. Moxey in the English office. That’s three (3). Do this as soon as you have completed the entire proposal.
Keep a copy for yourself. You will need it again in the spring.
The information on clearances is the last page of this document. It should be provided to the sponsor at the time of your first request for sponsorship. Some sponsors already have completed clearances on file with the district.
Completion deadline: 2/01/2017 Student LAST name:______FIRST name:______
CAPS PROPOSAL APPLICATION FORM (Part 1, Page 1)
Complete the following information either TYPED OR PRINTED IN INK. Please do not use pencil.
STUDENT NAME (last name, first) ______
PROPOSED SITE______
STREET ADDRESS (of the site) ______
CITY, STATE, ZIP CODE ______
SITE SPONSOR’S NAME (This is the person to whom you will report.) (Please print.)
______
E-MAIL ADDRESS______
SITE PHONE NUMBER______
Commitment/Authenticity Oath:
I understand all of my responsibilities in completing this project, including meeting all deadlines, meeting with my mentor, handing in my completed proposal, and completing the final oral presentation. I also understand that all work on my Graduation Project must be my original work. Any plagiarism or falsified forms will invalidate my project and will jeopardize my graduation. I also agree that failure to meet any of the requirements may result in an administrative review and appropriate consequences. In addition, I understand that if I fail to adhere to appropriate behavior and attendance requirements at my selected site, my CAPS privileges will be revoked, and I will return to school.
Student Signature______
Parent Signature______
Completion deadline: 2/01/2017 Student LAST name:______FIRST name:______
CAPS PROPOSAL APPLICATION FORM (Part 1, Page 2) Please answer the following questions regarding your planned placement. Complete this page prior to your first contact with a sponsor. Be sure to make note of the date.
1. Specify whether this is community service, a career placement, curriculum extension.
Community Service_____ Career Placement_____ Curriculum_____
**If this is career placement, your guidance counselor will be contacted to verify your plans.
2. Why did you select this site?
3. Describe your process of investigation into this site up to this point. For example, what have you read, with whom have you spoken? Have you discussed it with parents, teachers, friends?
Completion deadline: 2/01/2017 Student LAST name:______FIRST name:______
CAPS PROPOSAL APPLICATION FORM (Part 2, Page 1) Interview You may do the interview over the phone, in person, or by email. You should ask the site sponsor which she would prefer. You might be able to get some of the information through your own research. Even if you do not meet the individual in person, you will need to get her signature prior to the proposal deadline. If you are conversing with the individual via email, be sure to give her a (polite) deadline for your receipt of the information. Be sure that the deadline allows you time to complete the proposal by Feb. 1st, 2017
Before beginning any part of the interview or getting any signature, you must provide the prospective sponsor with the Requirements for Sponsors sheet. Is the sponsor willing and able to provide the district with these clearances? ____Yes ____No
You need to ascertain the following information in your interview: I. Regarding the work you will do A) Is the site able to accommodate the hours and times required? B) What is the dress code for the job? C) What training will be required before or during the field experience? D) What clearances/forms/medical exams needs to be completed and by what dates? E) What are the daily responsibilities of the position? F) How many other volunteers will be involved?
II. Regarding the site A) Are there other institutions/businesses/organizations in the area that fill similar roles? B) What is unique about this institution/business/organization? C) What is the mission statement of this organization?
III. The sponsor A) What is the best thing about working at this institution? B) What is the most challenging thing? C) How long have you worked here? 1. If this is a career-interest site: What do you think is the best route to take for a student wishing to enter this field? 2. If this is a community-service placement: What is the most important thing to know before volunteering here?
IV. Miscellaneous—Any other question you might have, or information you learned.
Upon completing the interview, you need to create a report in your own words, but in outline form, showing your collection of this data. Do not just write answers on this page. This report is due by February 1st, 2017.
Completion deadline: 2/01/2017 Student LAST name:______FIRST name:______
PROPOSAL APPLICATION FORM (Part 2, page 2) Signature of Site Sponsor
Sponsor’s name:______
Site:______
Phone number:______Email:______
I agree that I am able to and will provide the necessary clearances as described in the document provided to me by this student.
TO THE SPONSOR: Your signature below indicates that you have agreed to accept ______as an unpaid volunteer/intern/mentee (student name) in your organization during the dates and approximate times stated in the paragraph below. It also indicates that student has interviewed you regarding the daily requirements of the position and has been informed of any required training, paperwork, clearances, or medical testing he/she needs PRIOR to May 15th 2017. Please feel free to attach any documentation related to the above to this sheet. More information will follow in the weeks ahead and prior to the field experience; however, if at any time before or during CAPS, you have questions or concerns about the program, the student(s), or your involvement, please contact Tim Moxey at Lower Moreland High School: 215-938-0220, ext.2228, or [email protected].
The Lower Moreland CAPS field experience allows seniors the opportunity for a three-week, supervised volunteer experience for the purpose of providing community service or exploring possible career options. In 2017, the field experience runs from May 15th through June 7th. Students are required to be on site for a minimum of 5 ½ hours per day, including a half-hour lunch. Students MUST begin work at the site no later than 10 am. Students will need to contact Community Site Sponsors prior to the actual field experience to research both the organization and their roles as volunteers there during May. Students are required to know their on-site responsibilities prior to the field experience. Once the field experience begins, Community Sponsors will work closely with the student, the Lower Moreland administration, and faculty advisors to evaluate the student’s performance throughout the duration of the experience.
Additionally, I agree that I am able to and will provide the necessary clearances as described in the document provided to me by this student.
Sponsor signature: ______Date: ______
Completion deadline: 2/01/2017 Student LAST name:______FIRST name:______
PROPOSAL APPLICATION FORM (Part 3) Wait until you have all other parts of the proposal prepared to complete part 3. The questions below are not optional. You must provide full answers or your proposal will be rejected.
1. Describe at least two (2) specific things you hope to learn during your CAPS experience.
2. Describe two (2) fears or concerns you have about the CAPS field experience.
Completion deadline: 2/01/2017 Student LAST name:______FIRST name:______
LOWER MORELAND TOWNSHIP SCHOOL DISTRICT 2551 MURRAY AVENUE, HUNTINGDON VALLEY, PENNSYLVANIA 19006
CAPS Sponsor/Mentor Requirements
Lower Moreland Township School District is fortunate to have the support of our CAPS sponsors who provide a wonderful learning experience for our high school seniors. On December 31, 2014, changes to Pennsylvania’s Child Protective Services Law (CPSL) were made that impact the requirements for individuals serving as CAPS spnsors/mentors.
CAPS sponsors are now required to obtain and furnish to Lower Moreland Township School District the following clearances:
1) A Pennsylvania Criminal History Report—this can be obtained on-line and is free 2) A Pennsylvania Child Abuse Clearance Statement—this can be obtained on-line and is free 3) A signed Disclosure Statement (if you have been a resident of Pennsylvania during the entirety of the last 10 years) or FBI Criminal History (fingerprint) clearance if you have not been a resident of Pennsylvania continuously for the last ten years.—the cost of a FBI criminal history is $27.00 (payable by credit card when you register for it). You will be reimbursed by the School District for this cost.
Clearances are good for five years from the date that they are issued. Links to apply for the clearances and instructions can be found on the Lower Moreland Township School District on the main website (www.lmtsd.org) under the scrolling “Announcements” section. Please click on the link called “Information for CAPS Sponsors.”
Please note: a CAPS placement cannot start until the District has received these clearances. Please apply for them as soon as you agree to be a CAPS sponsor. We would like all clearances by March 15th, 2017 to allow time for processing.
We are committed to answering any questions that you may have and helping you in this process. Please contact Cheryl Galdo, Director of Human Resources/Public Relations, with any questions at 215-938-0272 or via e-mail at [email protected].
Thank you.
Completion deadline: 2/01/2017