Forms

“I’m beginning to see that I have a social responsibility to help other students with their disadvantages in order for them to be successful.” –Sp10 HCOM 317S Student

Service Learning Forms

Several of these forms are required for the student  placement  process.

The Service Learning Institute has two forms for risk management and database purposes that are required for community partners to initiate and maintain a partnership with the Institute.

Distance learning students will need to contact their Faculty and the Coordinator of Community Partnerships to get further information on how to complete your placement and establish a partnership with a new community partner.

Required Forms for Student Placement

1. Learning Agreement (Form 400)

This is the official document, which describes the students' specific responsibilities at their service learning site. The student, course instructor and site supervisor must sign the Learning Agreement. It is kept on file inthe SLI for 3 years. *Students can access this form via MySLP after completing the online placement process.
 

2. Activity & Time Log (Form 100)

This form is provided to assist you in tracking the activities and number of hours you served at your service learning site. Once completed and approved by your site supervisor, it provides verification of your service to the organization as well as a history of your contributions to the site. You are responsible for completing and returning this form to your service learning professor - check with your professor for the due date. Also, check with your site supervisor to determine if he/she would like a copy for the organization's records. *You can also access this form once logged in to  MySLP

3. Evaluation of Service Learning Process by Student 

ALL SERVICE LEARNERS - Due Date: before your last day of class

Each semester all students enrolled in SL courses will be asked to complete an online survey of the Service Learning process. An individual link will be sent to each student (via email) directing them to the Evaluation. This evaluation gives students the opportunity to evaluate the effectiveness of your Service Learning experience. The feedback that you provide on this form will assist the Service Learning Institute in improving the Service Learning program at CSUMB.

4. Evaluation of Service Learning Student Performance by Agency

This form is used at the discretion of the CSUMB faculty. Check with your instructor  to see if they require this form.

Your site supervisor will complete this assessment of your performance. Your service learning course professor will consider the remarks of this evaluation in determining your final grade in your service learning course. You are responsible for having your site supervisor complete this form after verifying your Activity & Time Log. In addition, it is your responsibility to return the completed form in a sealed envelope to your professor. Check with your professor for the due date for this form.

5. Monterey Peninsula Unified School District (MPUSD) Placement Forms A-D

Please talk to your instructor previous to choosing a MPUSD school site. For a list of participating MPUSD school sites please visit MySLP.

Each student wishing to serve at a Monterey Peninsula Unified School District school is required to attend an MPUSD Orientation and have completed the following previous to attending the orientation (no exceptions).

a. Student must have completed MPUSD Forms A-D.

b. Student must have their TB test results. For more information please follow up with your professor and refer to the TB Test guidelines.

c. Students MUST know the MPUSD school where they want to do their service. Students will be asked to choose a school site at the orientation.

d. Students must bring an official governmental photo ID to the orientation session. CSUMB ID cards are not acceptable.

Required Forms for Community Partners

A. University-Agency Agreement For Placement of Students (Form 200)
Printable

The University Agency Agreement for the Placement of Students (UAAPS) is a formal agreement between CSU Monterey Bay and a community-based organization, school district or governmental agency. The agreement specifies expectations for each party, and formally indicates how issues of liability and worker's compensation will be handled. The contract may be renewed every 5 years by agreement of both parties."

B. Community Site Visit Checklist (Form 300)
Printable

A tool for assessing the requirements, risks and basic safety factors of a site prior to student placement. A CSUMB staff or faculty person will visit a prospective organization and conduct a site visit. Prospective community partners of distance learners must complete and send this form to the Service Learning Institute prior to student placement.

Other Forms

CSUMB Release of Liability Form
Printable

This is used when service learners are asked to participate in activities or events not tied to a course on or off campus.

SLI Equipment Checkout Form
Printable

The SLI has a variety of equipement to assist in capturing media (flip cameras, camcorders, & digital cameras etc). SLI faculty and students enrolled in a SL course or working on Service Learning Capstone are welcome to use this equipement. Please read the second page for details regarding home use responsibilities. Please note a faculty signiture/consent is required prior to equipment being loaned out.