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Is form legibly in ink and have it approved by the student service learning (SSL) coordinator prior to earning SSL hours with an organization or opportunity that is not tagged as MCPS SSL Approved at the website www. mcpsssl.org. Maintain copies of all forms for your records. STUDENT INFORMATION To be completed by the student allowing 2 weeks for review by the school SSL coordinator. Student s Name Last First Parent/Guardian Phone: Home School Grade ID N.

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