Community Engagement Year-end Report

First Name *

Last Name *

Email

Please provide your email address - preferably your CSUN email address if you are student or faculty member.

Submission Type *

You are submitting this report as:

an instructor teaching a class that participated in community-based learning or service learning

a student participating in a community-based learning or service learning class

a member of a student organization or club that participates in co-curricular service within the community (this includes fraternities and sororities)

College *

Please state the semester and year for which you are reporting *

e.g. Spring 2018

Full Course Title *

Full Course Title1 *

Course Name and Number *

e.g. CHS 101

Course Name and Number1 *

e.g. CHS 101

Is your course designated as service-learning?

Yes

No

Was your course co-taught by another professor?

If you co-taught your class with another instructor, please list their name(s) below:

Section *

Class Number *

Is this a new service learning course?

Please indicate whether or not your course was newly flagged as service learning and added to the database the semester you are reporting.

Yes

No

Name of Student Club or Organization

Who participated in your service? *

Please indicate who participates in the services you are reporting.

Faculty

Staff

Students

Teachers

Number of students who engaged in service: *

Please provide the number of students in your class or organization who participated in the service you are reporting.

Community Partner(s) *

Please indicate the community based organization(s) (including K-12 schools) that your class, program or organization partnered with for the services you are reporting.

Under which categories does your community partners fall under:

Please check all that apply.

Please specify what type of community organization(s) with whom you are partnered:

Please identify the primary mission focus of your community partners.

Please specify the mission focus of your community partners:

In which ways are community partners involved in your student learning and student learning engagement?

Please check all that apply.

Act as uncompensated co-instructors

Act as compensated co-instructors

Assist in creating syllabi and/or designing courses

Come into classes as speakers

Provide reflection on site in community setting

Provide feedback on the development/maintenance of community service/volunteering/community engagement programs

Participate in the design and delivery of community-based courses

Serve on campus committees that determine learning goals and/or engagement activities

Other

Please specify community partner involvement:

Does your course accomplish any of the following? *

Focus on diversity

Build skills in deliberative discussion

Contribute to democratic participation

Involve simulations of democratic practices

None of the above

Do the student learning outcomes for your course include any of the following? *

Please specify student learning outcomes for your course:

Areas of Community Engagement *

Please indicate if students participated in any of the following areas:

Main Issues Addressed *

Please indicate the main issues provided by your project, program or organization.

Adult Programs and Services Sub Categories

Please indicate the type(s) of adult programs and services your project, program, or organization provided.

Animal Care Sub Categories

Please select the type(s) of animal care provided by your project, program, or organization.

Animal cruelty prevention

Animal protection

Animal welfare

Civic Engagement Sub Categories

Please select the type(s) of Civic Engagement services provided by your project, program, or organization.

Education Sub Categories

Please select the type(s) of educational services provided by your project, program, or organization.

Entertainment and Media Sub Categories

Please select the type(s) of entertainment and media services your project, program, or organization provided.

Environment Sub Categories

Please select the type(s) of environmental services provided by your project, program, or organization.

Health Sub Categories

Please select the type(s) of health services provided by your project, program, or organization.

Hunger and Homelessness Sub Categories

Please select the type(s) of hunger and homelessness services provided by your project, program, or organization.

International Relations Sub Categories

Please indicate the type(s) of international relations services provided by your project, program, or organization.

Military and Veterans Affairs

Please select the type of military and veterans affairs services provided by your project, program, or organization.

Public Safety

Please select the type(s) of public safety services provided by your project, program, or organization.

Social Justice Sub Categories

Please select the type of social justice service(s) provided by your project, program, or organization.

Youth Programs and Services Sub Categories

Please select the type(s) of youth programs and services provided by your program, project, or organization.

When did your service take place?

During regular academic sessions

During summer or winter breaks

Both during regular academic sessions and breaks

Frequency of Service *

Please indicate how often your class, club or organization provided the services you are reporting.

Weekly

Monthly

Annually

None of the above; I am reporting services provided for a service event

How many individuals did your service reach?

Please provide the approximate number of individuals that students served during the term you are reporting.

Project Support

Please indicate whether your project was supported by the following government programs:

Federal Work-Study

Corporation for National and Community Service programs

Grant Support

Please indicate which grant(s) you received for this project from our office.

Service Description *

Please provide a description of the services and community impact of your project, program, or organization completed. Please try to include: 1. The community need your project fulfilled/ the impact of your service in the community 2. How your project benefitted both the students involved and the population served

Estimate Hours *

Please estimate the average number of hours per week that a student served in the community.

Hours Per Week *

Please provide the average number of hours per week each student participated in community engagement.

Please describe results and student learning outcomes gained from this experience.

Quotes or student comments.

Awards or recognition related to this service learning course:

Did you track the number of hours students spent participating in community engagement? *

Yes

No

How does your club or organization engage alumni in community engagement activities?

Please select all that apply.

Communicates service opportunities to alumni

Coordinates day of service or service weekend activities for alumni

Cultivates alumni donors to support service activities

Gives awards to alumni for service

Invites alumni to serve as speakers or mentors to current students

Recognizes alumni for service in publications

Other

None of the above

Which of these resources are offered to alumni entering public service careers?

Please specify how you engage alumni in community engagement activities:

Please specify these resources:

What were your student learning objectives for this course?

Please describe results and student learning outcomes gained from this project:

Quotes or student comments/reflections:

Awards or recognition related to this project:

Other comments: