Submission form for SUCCESS STORIES on the NYSSLLI web site 

NYS Service Learning Region: 
Submitted by: 
email address: 
School: 
Date of project:

Title: 
Grade Level: 
Academic Areas: 
Duration of service: 
Character Virtues: 
Service Areas: 
 
Service Learning Project Description:



Goals and Objectives
Academic 
	Learning Goal: 
	Standard: 
	
	Learning Goal: 
	Standard: 

Service
	Community need: 
	Possible Community Partners: 
	Objective:
	Objective: 

Character
	Virtue: 
	Objective: 
	Virtue: 
	Objective: 

Key Activities
	Key Planning Activities
		1. 
		2. 
 	Key Service Activities 
		1. 
		2. 
		3. 
 	Key Reflection Activities 
		1. (oral)
		2. (written) 
		3. (performance) 

Celebration Activity
 
to Regional Directors: If you approve this project for posting 
please forward to mvanacore@gmail.com