This form is to be submitted before you begin a CAS activity. Your supervisor will check the details of your submissions and will inform you if the activity satisfies the IB requirements.

Students Name:
Date:
Tel no. :
Email:
Grade:
IB supervisor:
Name of Activity:
Please answer the following questions:
1.
Proposed date to begin
2.
Proposed date to end
3.
Your activity relates to which of the following (Select one or more of the titles below)
Creativity
Action
Service
4.
Briefly describe the activity
5.
What do you hope to achieve by doing this activity. Will you learn something new, improve on something you already have, develop new social skills etc.
6.
How will you measure or evaluate what you are doing or achieving. In some activities this will be difficult to do as it may involve things like improving social and interpersonal skills.
7.
Who will supervise what you are going to do? Please give the name, address and telephone number.
Name:
Address (if applicable):
Telephone No: