SERVICE-LEARNING FIELD STUDY
When Contract Section I, II, III are completed, give the white copy to instructor,
yellow copy to the Service-Learning Office, and keep the pink copy for yourself.
Student Name: ___________________________________ Telephone #: _________________________ Student B#: ____________________
STATE SERVICE AND LEARNING GOALS:
SERVICE: What exactly do you expect to do? Briefly describe the nature of the volunteer service work and why you have chosen it:
LEARNING: What do you expect to learn from this experience? (e.g. information and understanding about the elderly, people, environmental
issues, teaching methods, etc.)
SKILLS: What skills do you expect to develop and learn from this experience? (e.g. communication skills, writing, problem solving, teaching
In order to receive the Service-Learning Field Study one credit hour academic credit, I agree to: (1) Register for class; (2) Pay the fees; (3) Meet
academic and learning requirements (Section II); (4) Volunteer minimum of 20 hours; (5) Attend one mandatory Reflection Seminar; (6) Complete
documentation forms and (7) Complete a Service-Learning Student Questionnaire.
Student Signature: _____________________________________________________________________ Date: _________________________
The student named above has my permission to engage in this 4th or 5th credit
option service-learning experience to meet the requirement of ____________
(Faculty Instructor Completes)
2948. In-addition to the 20 minimum of service hours required, the student
will complete the following service-learning related assignments for the course.
1. r Journal
r Oral Presentation
r Other _______________________________________________________
2. One midterm reflection seminar arranged by the Center for Service-Learning and Civic Engagement is required. (See Section III)
3. Community Service-Learning Questionnaire must be completed at the end of the assignment.
4. Elaboration of evidence or academic work needed:
Faculty Member Signature: ______________________________________________________________ Date: _________________________
(Center for Service-Learning and Civic Engagement Completes)
r CSLCE Registration Form Completed
r Service Documentation Forms Received
Placement Site Selection: ___________________________________
Course and Section: _______________________________________ Faculty Instructor: ____________________________________________
Midterm Seminar Selection: Campus: _________________________ Date: _______________ Time: _______________ Room: ___________
The Service-Learning student has received Service-Learning documentation forms and is aware that the mid-term Service-Learning reflection
seminar is mandatory.
CSLCE Staff Signature: ___________________________________________________________________ Date: __________________________
CS-07 Rev. 6-14
3pt NCR Distribution: White (Faculty Member)