Fillable Form Cs-002 - College Placement Confirmation printable pdf download

Form Cs-002 - College Placement Confirmation

Download a blank fillable Form Cs-002 - College Placement Confirmation in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Cs-002 - College Placement Confirmation with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

and Civic Engagement

PLACEMENT CONFIRMATION

Cocoa 321-433-7610 • Titusville 321-433-5016 • Melbourne 321-433-5610 • Palm Bay 321-433-5253

Student Name:

____________________________________________________________________________________________________

Student ID#: ____________________________________________ Student Telephone: _______________________________

______________________________________

_____________________________

College Class:

Faculty Instructor:

Community Partner Name:

__________________________________________________________________________________________

Community Partner Supervisor: ______________________________________________ Telephone: _____________________

Duties: ________________________________________________________________________________________________

Days and Hours: ___________________________ Starting Date: __________________ Ending Date: ____________________

Student is working as Community Service-Learner/Volunteer:

Yes

MUTUAL EXPECTATIONS AGREEMENT

I. COMMUNITY PARTNER/PLACEMENT SITE - We commit to the following:

• To provide an adequate position description, orientation/training, and the final decision in

accepting a student as a service-learner or volunteer

• To provide supervision, feedback, and evaluation on student performance

• To respect the individual and learning needs of the student

• To provide meaningful tasks related to skills, interests, and learning objectives

• To provide appreciation and recognition of the student’s contributions

• To provide a safe and appropriate working environment

II. COMMUNITY SERVICE-LEARNER - I commit to the following:

• To perform my respective duties to the best of my ability

• To adhere to the organizational rules, procedures, and policies including the confidentiality

of organization and client information

• To be open to supervision with mutual feedback which will facilitate service-learning growth

• To meet time and duty commitments or if I cannot attend to provide adequate notice so that

alternative arrangements can be made

III: AGREED TO:

Community Partner Placement Site Signature: __________________________________Date: _______________

Community Partner Verification of Student Photo ID: _____________________________Date: _______________

Community S-L Student Signature: ____________________________________________Date: _______________

CS-002

Rev.2-14 3pt NCR

Distribution: White (Faculty Member)

Yellow (Center for Service-Learning and Civic Engagement)

Pink (student)

Form Cs-002 - College Placement Confirmation

Related Articles

Related forms

Related Categories