| Student
Forms
Required Forms
1. Placement Form
a) LIBERAL STUDIES Students
Completing this form is necessary in order
to match your interests and skills with the opportunities
available at the school placement sites. Choose placement
sites from the list of schools that have been pre-approved
for your specific course. Once you have submitted your Placement
Request Form, your choices will be reviewed and you will
be assigned a final site. You are not guaranteed your first
choice of schools. Your final assignment will be emailed
to the email address, which you provide on this form. If
you have any questions, please call the Service Learning
Institute Coordinator of Community Partnerships at 582-4184.
Click to access Placement
Form – Online Planner Web
b) ALL OTHER Students - Due
Date: before your first official day of service at your
placement site
The Service Learning Placement Form provides
the Service Learning Institute with accurate information
about your Service Learning placement. On this form, you
are required to select your placement site from the
list of pre-approved Community Partners that appear in
the drop-down box. This form
becomes the official record of your service learning placement
for the semester.
Click to access Placement
Form – Online Planner Web
2. Learning Agreement (Form 400)
(As MS
Word Document) (As PDF
Document)
Your faculty/instructor will
provide you with a copy of this form in class. 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 by the academic department, for
3 years.
3. Activity & Time Log
(As MS
Word Document) (As PDF
Document)
This form is provided to assist you in tracking
the activities and number of hours you serve 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.
4. Student Evaluation of the Service Learning
Experience Form (Return
to top)
ALL SERVICE LEARNERS
- Due Date: before your last day of
class
This form gives you 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.
Click to access Student
Evaluation of the Service Learning Experience
Optional Form (Return
to top)
Note: This form/tool is not returned to SLI,
it is for course use only and used at the discretion of the
faculty person. Check with your faculty person to see if it
is necessary.
Student Performance
Evaluation by Site Supervisor
[As MS
Word Document] [As PDF
Document]
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.
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