Century Elementary 4^th Grade Block C Award

Student Name	Grade Teacher Name	Year

MIND	
Honor Roll, High HonorRoll, or Principal's Honor Roll 3.0-4.0

1st Q

2nd Q

3rd Q

4th Q

(*All fourquartersrequired) |

BODY | 1 Pointeach | Advisor Initials
Superintendent's Award or Healthy Fitness | |
Competition Pep/Cheer (YEAR ROUND) | |
GameCheer (FALL and WINTER) | |
Cross Country(FALL) | |
Wrestling (WINTER) | |
Track (LATE SPRING) | |
2 pts required 4^th | |

SERVICE

Pts.

Advisor
Initials

Character Counts Award(Tiger of Month) | |
4^th Grade Representative(second semester) | |
Sports Manager | |
Buddy Bench (Max 2 pts) | |
Positivity Project Challenge (25or more) | |
School Service Contract | |
3 pts required 4th | |

SPIRIT | 1 Pointeach | Advisor Initials
Drama | |
Oral Interpretation | |
Science Olympiad | |
Robotics(Teams form on their own) | |
GATE | |
Essay Contest (SchoolApproved) | |
Cultural Project Presentation | |
Game Cheer (single season FALL or WINTER) | |
3 pts required 4th | |

Block C Application

Name:______________________ Grade ____	Teacher ___________ Rm._____

Rules:

1. The student must complete the correct number of items in each area to be eligible for Block C. 2. Students who are suspended for disciplinary reasons are not eligible for Block C
3. Students receiving more than two office referrals requiring administrative intervention are not eligible for Block C.
4. Any student with 6 unexcused tardies and/or unexcused absences during the school year shall not be eligible for Block C.
5. Students that have a “D”, “F”, or “N” on a report card are not eligible for Block C.

Summary | Teacher Signature/Check off
MIND |
BODY |
SPIRIT |
SERVICE |
RULES 1-5 |

By signing below, I certify that the above is true and accurate:

Student Signature: ________________________	Parent Signature: ___________________________

*Important Information: School Service Contracts
School service contracts must be signed, dated, and approved by administration prior to students beginning the contract and when the work is complete. Most contracts should consist of at least five 30-45-minute sessions unless otherwise noted. Students will be given opportunities throughout the year to complete service contracts. Several opportunities for service credit will be on the Century website “Block C” tab. April 1^st is the last day administration will sign a service contact. Students will receive a document/receipt when contract is completed. Students should keep that document with this Block C checkout sheet.

* Important Information: Availability of Spirit and Service points
Depending on personnel, some clubs may or may not be offered during a school year. Furthermore, at times the school may introduce new opportunities that will count as points for Block C.

(Revised 6/30/23)