CBL Pre-Service Contract
Basic Information
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1
. Name
Name
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2
. Email
Email
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3
. Cell Number
Cell Number
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4
. Placement Site: Each program runs from approximately 3pm-6pm, Monday-Thursday
Placement Site: Each program runs from approximately 3pm-6pm, Monday-Thursday
Choices (Grades 6-8)
Connections (Grades 2-5)
Homework House (Grades K-8)
Other (please specify)
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5
. Transportation
Transportation
I will take the UMass Community Service Bus, which leaves at 2:50pm each day from the Peter Pan Bus stop on 116 outside the Thirsty Mind.
I will take my own vehicle.
Other (please specify)
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6
. Schedule: Which day(s) of the week do you plan to attend?
Schedule: Which day(s) of the week do you plan to attend?
Monday
Tuesday
Wednesday
Thursday
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7
. Did you find this placement through:
Did you find this placement through:
Community-Based Learning Course (Psych/Ed 233)
Community-Based Learning Course (Psych/Ed 205)
Off-Campus Work-Study
CAUSE (Volunteer Organization)
Other (please specify)
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