Form Cs-07 - Service-Learning Field Study - 4th And 5th Credit Option Contract Form printable pdf download

SERVICE-LEARNING FIELD STUDY

AND

CREDIT OPTION

CONTRACT

When Contract Section I, II, III are completed, give the white copy to instructor,

SECTION I

(Student Completes)

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

techniques, etc.)

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

SECTION II

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.

REQUIREMENTS:

1. r Journal

r Oral Presentation

r Final

r Essay

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: _________________________

SECTION III

(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)

Yellow (CSL)

Pink (Student)

Form Cs-07 - Service-Learning Field Study - 4th And 5th Credit Option Contract Form

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