Appendix B
Hanover High School
Culminating Project Proposal Form
(Page 1 of 2)
Name: Student Name Here
Mentor: High School Mentor Teacher
Advisor/Community Service Supervisor (if applicable): Mrs. X
Title of Project: Hanover Hospital Community Service
Project Beginning Date: October 22, 2007 Project Completion Date: November 2008
Purpose/Objectives:
• To complete 30 hours of community service at the Hanover Hospital during the summer
of 2008.
Reason for Selection:
• I would like to pursue in a career in the medical field and this would give me a great
opportunity to see what it is really like inside a hospital. I think doing community service
at the hospital would give me a better feel for the environment and it will be good for my
people skills and college applications.
Completion Strategies:
• Select agency (Hanover Hospital)
• Contact person in charge of community service at the hospital (Mrs. X)
• Get signature/approval from Mrs. X
• Serve 30 hours of community service (Summer 2008)
• Work on presentation after completion of 30 hours
Project Timeline:
• November, 2007: Contact Mrs. X at the hospital
• November, 2007: Get signature from Mrs. X and parents- submit proposal
• Summer, 2008: Serve 30 hours of community service at the hospital
• After completing the hours, work on presentation during the summer and fall of 2008
Resources and Materials:
• Digital camera (for taking pictures at hospital, if allowed)
• Powerpoint
Approximate Cost (to be provided by student): N/A
Hanover High School
Culminating Project Proposal Form
(Page 2 of 2)
Form of final product: exhibit, product, other:
• PowerPoint presentation to illustrate the work that I did at the hospital and why it was
important.
Community Service:
If the student elects to complete a minimum of 30 hours of community service in lieu of the
project, a check must be placed in the box preceding community service and the information
pertaining to letters A-C below must be provided.
A. A description of the proposed service
• I will be giving back to the community by helping the patients and staff
members in the hospital, I will learn about the environment I plan on
working in, and I will be completing my senior project.
B. The location where the service will be completed:
• Hanover Hospital
C. The signature of the community service supervisor must be obtained below.
Signatures: Dates:
Student _______________________________________________________________________
Mentor _______________________________________________________________________
Parent or Guardian ______________________________________________________________
Advisor (if applicable) ___________________________________________________________
Community Service Supervisor (if applicable):________________________________________
Support Staff (optional) __________________________________________________________
Committee Review Person________________________________________________________
Approved / Disapproved