Fillable SEEDS Program Completion Checklist FINAL

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SEEDS Program Completion Checklist FINAL

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SEEDS Program Completion Checklist – 50 points total
Submit to your mentor -- Prof. Waverly Ray (SB110C) or Prof. Leticia Lopez (G238) – by Fri 3/11/16
Student Name: Date: _
Mesa College Cumulative GPA: Units Completed at Mesa: _
Date You Plan to Graduate from Mesa: ____________________
The goal is for SEEDS Scholars to earn fifty points upon completion of the program. The fifty points are divided
evenly among five categories: Academics, Leadership, Experiential Learning, Volunteerism, and Mentorship. In
order to be eligible for the SEEDS Scholar stipend in May 2016, twenty-five points must be earned and this
checklist submitted by Friday, March 11.
Please contact your SEEDS Mentor with any questions that you have when completing this checklist.
ACADEMICS
1. SEEDS Courses (3 points per course). Indicate the course number, semester taken, and grade received.
a. ________________________________________________________________________________________
b. ________________________________________________________________________________________
c. ________________________________________________________________________________________
d. ________________________________________________________________________________________
e. ________________________________________________________________________________________
f. _________________________________________________________________________________________
SEEDS Courses Point Subtotal: _____
2. SEEDS Honors Contracts (2 points per contract). Indicate the course number, semester taken, and grade
received. And, submit the Honors project to your SEEDS Mentor.
a. ________________________________________________________________________________________
b. ________________________________________________________________________________________
c. ________________________________________________________________________________________
d. ________________________________________________________________________________________
e. ________________________________________________________________________________________
f. _________________________________________________________________________________________
SEEDS Honors Contracts Point Subtotal: _____
3. SEEDS Class Project (1 point per course). Indicate the course number, semester taken, and grade received.
And, submit the project to your SEEDS Mentor.
a. ________________________________________________________________________________________
b. ________________________________________________________________________________________
c. ________________________________________________________________________________________
d. ________________________________________________________________________________________
e. ________________________________________________________________________________________
SEEDS Class Project Point Subtotal: _____
4. Education Plan (1 point). Education Plan submitted to your SEEDS Mentor: Yes No
Education Plan Point Subtotal: _____
5. Progress Report (1 point per semester). Progress reports submitted to your SEEDS Mentor: Yes No
Progress Report Point Subtotal: _____
Academics Point Total: _____
LEADERSHIP
1. Leadership in Student Clubs (5 points per experience). Indicate the student club, position, and semesters.
a. ________________________________________________________________________________________
b. ________________________________________________________________________________________
c. ________________________________________________________________________________________
d. ________________________________________________________________________________________
e. ________________________________________________________________________________________
Leadership in Student Clubs Point Subtotal: _____
2. SEEDS Internship or Work Study (5 points per experience). Indicate the semester and hours worked.
a. ________________________________________________________________________________________
b. ________________________________________________________________________________________
c. ________________________________________________________________________________________
d. ________________________________________________________________________________________
e. ________________________________________________________________________________________
SEEDS Internship or Work Study Point Subtotal: _____
Leadership Point Total: _____
EXPERIENTIAL LEARNING
1. SEEDS, USDA, and related Workshops, Conferences, and Field Trips (2 points per experience; 3 points if you
were a facilitator at the event). Indicate the workshop/conference/field trip name and dates.
a. ________________________________
________________________________________________________
b. ________________________________________________________________________________________
c. ________________________________
________________________________________________________
d
. ________________________________
________________________________________________________
e. ________________________________
________________________________________________________
f. ________________________________
_________________________________________________________
g
. ________________________________
________________________________________________________
h.
________________________________
_________________________________________________________
i.
________________________________
_________________________________________________________
j.
________________________________
_________________________________________________________
k. _________________________________________________________________________________________
Experiential Learning Point Total: _____
VOLUNTEERISM
1. Volunteer Activities (1 point per hour volunteered). Indicate the volunteer location, date, and hours
wo
rked. Include both on- and off-campus activities.
a. ________________________________
________________________________________________________
b
. ________________________________
________________________________________________________
c. ________________________________________________________________________________________
d
. ________________________________
________________________________________________________
e. ________________________________
________________________________________________________
f. ________________________________
_________________________________________________________
g
. ________________________________
________________________________________________________
h.
________________________________
_________________________________________________________
i.
________________________________
_________________________________________________________
j.
________________________________
_________________________________________________________
Volunteerism Total: _____
MENTORSHIP
1. Advising Meetings (1 point per meeting). Check all that apply.
September 2015 October 2015 November 2015 February 2016 March 2016
Advising Meetings Point Subtotal: _____
2. Peer Mentorship (1 point per activity). Check for each service/opportunity that you received peer
mentorship from during Fall 2015 and Spring 2016.
Academic Skills Center
Writing Center
Peer Navigators
Classroom Tutors
Honors Students
Phi Theta Kappa Students
Student Club: __________________________________
Peer Mentorship Point Subtotal: _____
Mentorship Point Total: _____
Grand Total (all categories): _____
CERTIFICATION
I certify that all the information provided in this SEEDS Program Completion Checklist is accurate and
complete, to the best of my knowledge. I understand that providing false information is grounds for dismissal
from the program.
Student Name (printed): _____________________________________________________________________
Digital Signature: ___________________________________________________________________________
Date: ______________________
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Reviewed by: _________________________________ Date: ____________________________
Comments: ___________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Stipend Amount Approved: ____________________ Date: ________________________
FOR OFFICE
USE ONLY
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Completed 18 February 2020

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