Student Service Learning Agreement

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* 1. Student Information

First Name:

Last Name:

Tartan ID#:

e-Mail:

Please make sure the Tartan ID# box is filled out, as it helps us with the upkeep of our database and fluency of our records. Thank you!

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* 2. Course Information:

Course Name: (ex BIS)

Course #: (ex 2160)

Instructor:

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* 3. What semester did your service event take place?

Fall

Spring

Summer

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* 4. Project Information:

Project Name:

Agency/Organization:

Agency Contact Name:

Agency Contact Phone:

Agency Contact e-Mail:

Anticipated # of Hours Projected:

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* 5. Please read the following statements to see what is expected of you during the service learning event:

I will comply with all school and agency/community site rules, regulations, policies, and procedures.

I will conduct my service learning activities at the agency/community site, under the supervision of the designated employee or representative of the agency/community site.

I will be punctual and conscientious in my attendance for the time of my service learning activity.

I will notify the supervisor or the agency/community site, in advance if I am unable to participate as scheduled.

I will consider as confidential all information concerning other people, clients, employees, and agencies/organizations.

I will make my work at the agency/community site the highest quality.

I will accept supervision and follow all directions during the service learning activity.

I will conduct myself with dignity, courtesy, and consideration. I will notify my instructor of any problems, emergencies, safety hazards, concerns, or suggestions regarding my service learning activities or community site.

I will complete all assignments related to my service learning activity.

I will arrange my own transportation to and from the service learning site.

I will obtain written permission from the agency/community site before publishing any material related to my service learning activity at the site.

I understand that while engaged in the Service learning activity I am not an employee of Sinclair Community College or the agency/community site.

I agree to these terms.

I do not agree to these terms.

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* 6. By typing my name below, I understand that while participating in a service learning activity of my Sinclair Community College course, I must act responsibly, and I agree to the above conditions.