Service-Learning Registration 2013 Spring
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1
. Student ID Number
Student ID Number
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2
. Last Name
Last Name
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3
. First Name
First Name
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4
. Email
Email
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5
. Phone Number (Where you can actually be reached)
Phone Number (Where you can actually be reached)
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6
. Your Instructor/s must approve your Service-Learning activities for credit in each specific course. The connection of service with academics is key. If you have secured approval, please enter your course information here.
Your Instructor/s must approve your Service-Learning activities for credit in each specific course. The connection of service with academics is key. If you have secured approval, please enter your course information here.
Instructor's Name (Last, First)
Course Code/Number (ie: SO200)
Course Title (ie: Intro to Sociology)
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7
. Are you doing Service-Learning for more than one instructor?
Are you doing Service-Learning for more than one instructor?
Yes
No
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. If you are doing Service-Learning for more than one course, be sure that EACH instructor knows about ALL the other courses for which you’re “counting” your S-L activities. They may require additional assignments/hours. Enter additional courses here.
If you are doing Service-Learning for more than one course, be sure that EACH instructor knows about ALL the other courses for which you’re “counting” your S-L activities. They may require additional assignments/hours. Enter additional courses here.
2nd Instructor's Name (Last, First)
2nd Course Code/Number (ie: SO200)
2nd Course Title (ie: Intro to Sociology)
3rd Instructor's Name (Last, First)
3rd Course Code/Number (ie: SO200)
3rd Course Title (ie: Intro to Sociology)
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9
. Student Information
Student Information
Age
Gender
Ethnicity/ies
Major
Number of years at Chaminade
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10
. Class Standing
Class Standing
Freshman Day Undergraduate
Sophomore Day Undergraduate
Junior Day Undergraduate
Senior Day Undergraduate
AEOP
Graduate Student
11
. Languages spoken FLUENTLY other than English
Languages spoken FLUENTLY other than English
Lang 1
Lang 2
Lang 3
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12
. Have you done Service-Learning at Chaminade before?
Have you done Service-Learning at Chaminade before?
Yes
No
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13
. Have you done Service-Learning at any other school?
Have you done Service-Learning at any other school?
Yes
No
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