* 1. Name:

* 2. Graduation Year:

* 3. Professor:

* 4. Course:

* 5. Community Agency:

* 6. Name of Supervisor:

* 7. Number of hours served throughout the semester:

* 8. Did the community organization provide an orientation for you?

* 9. Please indicate your responses to the following statements using the scale provided.

  Strongly Agree Agree Neutral Disagree Strongly Disagree Not applicable
I was able to easily get in touch with the community agency.
The agency provided me with adequate supervision.
I understand the connection between my service experience and course content.
The service experience helped me better understand the course concepts.
The service activities I performed for this class made me more interested in the course.
The hours required of me for the service activities were reasonable.
The reflection activities helped me understand the connection between my service activities and the course content.

* 10. Please continue to indicate your response to the following statements.

  Strongly Agree Agree Neutral Disagree Strongly Disagree Not Applicable
Because of this course, I feel a greater sense of responsibility toward my community.
Through this experience I attained a greater awareness of the needs and problems of our community and the factors that create them.
I would be interested in taking another service-learning course.
I would recommend service-learning courses to my friends.
The service raised my awareness of potential career options.

* 11. Please describe your service activities:

* 12. What were some positive outcomes of your service-learning experience?

* 13. Did you experience any problems or issues at your site or with your service experience?

* 14. If yes, please describe the problems or issues.

* 15. Have you taken other courses that include service-learning?

* 16. If yes, please list the courses:

* 17. Please list any changes, suggestions or areas of improvement you would recommend regarding service-learning in this course.

* 18. Additional thoughts or comments: