JMA Service as Action Reflection Form
6th & 7th graders: Complete this form each time you participate in a Service as Action activity. This is how you will reflect on your service and document it's completion.

Use this form to reflect on grade level activities and individual choice activities. After you complete the form, you will receive a confirmation email.


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Student Email *
Last Name *
First Name *
Grade *
Last Name of your Homeroom Teacher *
Was this the grade level activity or an individual choice activity? *
Name of Activity *
Date of Activity *
MM
/
DD
/
YYYY
Location of Activity *
Briefly describe this activity, including what tasks you completed and what person, organization, or issue benefited. *
Which of the following Service as Action learning outcomes were addressed through this activity? Check all that apply. *
Required
Reflect on your activity. Include what you learned from the activity, what you would do differently if you repeated the activity, and how you met the learning goals you checked above. *
Which IB learner profile did you MOST develop through this activity? *
In what way did you demonstrate this learner profile through your service? *
What is the name of the activity supervisor & how can we contact them? Please provide a phone number or email. *
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