Name: Diana Rios

Date: September 6, 2016

Period: 4B

High School & Community Service Activities Record

Place an X for each corresponding grade you participated in the following school activities. Please be
extremely thorough in listing all activities.

Community Service (volunteer work)

Served at an orphanage
Teacher assistant
STAFF at Health Event

Hours
8
120
8

9th

10th 11th 12th

X

X
X

Organizations, Clubs, Activities & ASB (please note any leadership roles)

9th

10th 11th 12th

Special Talents & Hobbies

Dance

9th
X

10th 11th 12th

X

Athletics, Cheer, Dance, Theater, Band

Folkloric Ballet
Teen Jazz

9th
X

10th 11th 12th

Awards, Honors, and Other Achievements

2nd place in school-wide math contest
Citizenship Award
Honor Roll
Academic Distinction Award
Jobs

9th
X

10th 11th 12th

X
X

9th

10th

X
X
11th 12th

Name: Diana Rios

Date: September 6, 2016

Period: 4B

High School & Community Service Activities Record (For

University of California)
In addition to your courses and grades, we want to know about any honors youve received and how you spend your time
outside of school. Use this worksheet to prepare concise descriptions of your most significant awards and activities. You may
list up to five entries in each category, so think carefully about what you want to highlight. Also make sure to fully describe
each item (up to 160 characters) for admissions offices to best understand your involvement.
Coursework Other Than AG List the courses you took during high school, other than those
approved for UC admission, that demonstrate a particular focus or interest (e.g., language immersion
courses or nontransferable college courses).

9th

Course Name

Description of Course

Marketing

Students learn about buyer behavior, marketing

research principles, demand analysis, distribution,
financing, pricing, and product management.

Educational Preparation Programs List your participation in educational or academic

preparation programs that are designed to help students prepare for university study. These programs may include
academic enrichment programs sponsored by colleges/universities, research programs and study-abroad programs.

Program Name

Organization

Description of organization and your responsibilities

Raymundo Muzquiz
Ayala

I was the Math teacher assistant and I helped by

grading my peers, helping and teaching them, and
organization of the classroom.
Me and other person had to take care of a
3-year-old and make her happy for a day, in
celebration of the day of the children in Mexico.
Their main purpose is health related community
service.I was part of the kids entertainment on one
of their events. I painted their faces and gave them
toys.

Lions Club
International

Work Experience List paid work only.

Job Title

11th

12th

Hours
Per
Week

Weeks
Per
Year

3-4

24

Hours
Per
Week

Weeks
Per
Year

Hours
Per
Week

Weeks
Per
Year

Hours
Per
Week

Hours
Per
Week

(Summer)

(Sch. Yr)

9th

10th

11th

12th

9th

10th

11th

12th

Description of Program

Volunteer and Community Service List unpaid work only.

Gracia del Calvario

Orphanatory

10th

Responsibilities

9th

10th

11th

12th

Begin
Mo/Y
r

End
Mo/Y
r

To what use have you or will you put your earnings?

Awards and Honors List and briefly describe the most significant awards you have received since the beginning of 9th grade.

Award or Honor Type

Date

Award or Honor

2nd place in
school-wide math
contest
Citizenship Award

Honor Roll

Academic Distinction
Award

Description of Award or Honor

Academic

The school held a school-wide math contest. Won second place

2014

Given to students who exemplify superior honor and discipline within

the classroom environment.

Awarded to full-time students with a grade point average of 3.5 and

higher with no Ds

Recognition for earning a 3.89 GPA as of 11th grade

June
9,
2015
June
9,
2015
June
16,
2016

Extracurricular Activities List and briefly describe the activities you have been involved in
since the beginning of 9th grade.

Activity

Description of Activity

Folkloric Ballet Club

Emphasizes in local folk Mexican culture with

ballet characteristics such as: pointed toes and
exaggerated movements. I stayed in the club for 3
years
Dancers learn the basic of jazz technique while
moving at a pace better suited for the needs of a
beginner teen.

Teen Jazz Class

9th

10th

11th

12th

Other

Receive
d

Hours
Per
Week

Hours
Per
Year

2.5

60

This worksheet is adapted from the Activities and Awards Worksheet portion of the application for admissions to the University of California.