Clearinghouse Form for Service Learning

In an effort to capture the Service Learning projects that are currently being used in each department, the Service Learning Committee has created this form to document the array of activities provided for our students.

This information will be kept by the committee and used for documentation and information purposes only. After you have completed your Service Learning activities, please complete this form which will automatically be forwarded to the Chairperson of the Service Learning Committee.

Thank you.

Name of Activity or Project
Course Name and Number
Instructor
Start Date of Project Start Date of Project / MM / DD YYYY
End Date of Project End Date of Project / MM / DD YYYY
Cost
Was the project grant funded?

Was the project grant funded? Yes No
If yes, what was the name of the grant?
Brief summary of the service learning project
Materials and resources used
Objectives of the course syllabus met by this project
Partner organization description
Name and contact information for community partners
Estimated number of hours for project completion: (include time spent planning, gathering resources, implementing activities, and evaluating the project)
Number of students participating in this project
If you have student feedback from project, or if you sought or received publicity as a result of this project please indicate results here.
Please check all of the elements of Service Learning that were addressed by this project

Please check all of the elements of Service Learning that were addressed by this project Preparation Student Voice Diversity Collaboration Curriculum Integration Service Reflection Assessment Evaluation