Appalachian State University s4

Service-Learning Project Agreement Form

University of Florida • Center for Leadership and Service • Division of Student Affairs 301 Peabody Hall • P.O. Box 114135 • Gainesville, FL 32611 Phone: (352) 392-1215 • Fax: (352) 392-1213 • Email: [email protected] www.leadershipandservice.ufl.edu

The purpose of this agreement is for you, in conjunction with your instructor and your community partner supervisor, to outline the goals, activities, and learning objectives for your service-learning experience. Please be as explicit as possible when completing the following agreement (type your answers on a separate sheet of paper if you prefer). For assistance with locating an appropriate service opportunity for your project, please stop by Center for Leadership and Service.

CONTACT INFORMATION

Student Name Address E-Mail Phone

Instructor Name(s) Campus Address E-Mail Phone Course Title Course # Section

Community Partner Name Address Supervisor Position E-Mail Phone

SERVICE-LEARNING PROJECT What is the organization’s mission?

Position Description Describe in detail what your role and responsibilities will be at the community organization. List your duties, projects that you will be involved in, deadlines, etc.

Using your course syllabus, explain how this experience will connect to the course objectives and/or course topics. Supervision Describe in detail the supervision that you will receive at the organization. Describe the type of training/assistance that you will receive. Who will provide this for you? Who will you speak to if any problems arise at the organization?

Evaluation What criteria will be used to evaluate your work performance? How will this evaluation be conducted? Who will complete this evaluation?

Minimum number of service hours that you have agreed to complete Start Date / / End Date / /

LEARNING OBJECTIVES & ACTIVITIES Learning Objectives Describe in detail what you hope to learn through this experience. How will you evaluate if you have met your learning objectives?

Learning Activities On-Site: Describe how your service-learning activities will enable you to meet your learning objectives. Please list projects, research, conversations, etc. and relate them to your learning objectives.

Off-Site: Please list readings, writing, etc. that you will complete that will help you meet your learning objectives.

Evaluation What criteria will be used to evaluate your academic performance with this project?

AGREEMENT

By signing this form, you agree to the conditions stated above.

Student’s Signature Date Instructor’s Signature Date Supervisor’s Signature Date

Note: Once you have obtained the necessary signatures, please make 3 copies of this form (1-Student, 2-Instructor, 3-Community Partner).