Service-Learning Intake Form Survey

The Center for Community-Based Learning is pleased to offer a variety of ways to support a range of service opportunities in an academic setting for Lasell students:
• In-class presentations to explore the question “How Do You Define Service”
• Coordination of service around a theme where students spend a set number of hours helping at a community organization related to their coursework.
• Facilitate the Linked Credit program for students engaging in 15-20 hours of service and writing a reflection paper for an existing 3-credit course.
• Support of service-learning projects where students and community organizations engage in mutually beneficial projects that the students reflect on extensively through classroom work.

To best support you and your class, please provide us with the following information by Feb. 1, 2012. A CCBL Staff Member will follow-up with you shortly to begin working with your class.

1. Faculty/Instructor Name

Faculty/Instructor Name

2. Course Number and Title

Course Number and Title

3. Number of students in your course that will be expected to engage in service?

Number of students in your course that will be expected to engage in service?

4. Number of hours of service you are requiring/suggesting each student complete.

Number of hours of service you are requiring/suggesting each student complete.

5. Will you want support designing a service project for the whole class (or small groups) to engage in? If the answer is yes, do you need:

Will you want support designing a service project for the whole class (or small groups) to engage in? If the answer is yes, do you need: Individual student projects

Small group projects

Whole class project

Other (please specify)

6. Types of support you would like from the CCBL:

	Yes	No
CCBL monthly e-newsletter with a schedule of service opportunities	*Types of support you would like from the CCBL: CCBL monthly e-newsletter with a schedule of service opportunities Yes	CCBL monthly e-newsletter with a schedule of service opportunities No
Presentation in your class from a CCBL Staff Member	Presentation in your class from a CCBL Staff Member Yes	Presentation in your class from a CCBL Staff Member No
Reflection activities about service	Reflection activities about service Yes	Reflection activities about service No
Receive resources/readings on service topics	Receive resources/readings on service topics Yes	Receive resources/readings on service topics No
Syllabus design to incorporate service	Syllabus design to incorporate service Yes	Syllabus design to incorporate service No
Transportation coordination	Transportation coordination Yes	Transportation coordination No

7. Describe your course learning objectives and how you would like a service component to enhance those objectives.

Describe your course learning objectives and how you would like a service component to enhance those objectives.

Service-Learning Intake FormExit this survey

Service-Learning Intake Form
Exit this survey