Activity Proposal Form

DOES AN ACTIVITY QUALIFY?

Student Name: _____Andrej Simicevic_______

You must have your CAS activities approved in advance by the CAS Coordinator. This sheet will help you
determine if your planned activity is suitable for your CAS portfolio.
Complete the guiding questions below and complete the CAS Activity Evaluation Rubric on the back of this
sheet and send to CAS coordinator on e-mail: tatjanaracic1@gmail.com. Activity will be approved or
rejected.

 Activity title:

 Activity description: (What are you planning to do? e.g. start playing football)

 Type of activity: (Underline one or two!) Creativity Action Service

 Duration and amount: (How many hours/week?)

 Is the activity a new role for me?

 Is it a real task that I am going to undertake?

 Does it have real consequences for other people and for me?

 What do I hope to learn from getting involved?

 How can this activity benefit other people?

 How does this activity relate to the Learning Outcomes?

 How can I reflect on this activity?

Have you found an adult supervisor yet?

Email address is: arsesale@gmail.com
Name is: Aleksandra Arsenijević Puhalo
(Cannot start this activity without this information)

DOES AN ACTIVITY QUALIFY?

Circle/highlight the box that best describes your proposed activity and add together the
points this indicates.
 1 point 2 points 3 points 4 points

A Challenge Attendance only Gives opportunity Presents a difficult Pushes student

required for student to and challenging beyond previous
extend him/herself target limits

B Opportunities for No benefit other Has some benefit Outcome is Results in

service, benefit to than to student to others directed towards identifiable benefit
others benefiting others to others

C Acquisition of skills No level of skill Requires skills any Develops existing Develops new
and interests rather required student of this age skills skills
than practicing would be expected
those already already to have
acquired

D Initiation and Activity organized Activity organized Organized by Planned, organized

planning by by school by outside agency group of students and run by
students with adult leader student(s)

E Establishing links Does not involve Involves working Involves working Involves working
with community working with within the school with the with and within
and furthering others community only community but the local
international may only be with community and/or
understanding student’s own in the local
nationality or language
international
community

F Active rather than No active Student required Requires active Requires active
passive nature participation to participate but participation participation and
not initiate input from student

G Project nature - Activity ‘one-off’ of Combines two Has elements of all Has a good
combining a range short duration only activities on more three activities on balance of three
of activity one type than one occasion more than one activities
(Creative, Action or one for longer occasion or two for combined into a
and Service) duration longer duration long term project

Total Points: ____

A high score indicates your activity may well qualify for your CAS portfolio.
CAS Advisor: ______________________________________ approved: yes  no 
Signature CAS Advisor: _________________________________
Suggestions: ___________________________________________________________________