CE Medal Application 2019

Eligible candidates must submit all application materials before the submission deadline (Friday, March 22nd, 2019 at 5pm) and demonstrate that all medal requirements will be complete prior to the end of the Spring 2018 term. For full eligibility requirements, all applicants should review the application FAQs and list of eligible courses thoroughly before completing the application form.

Full Name *

CWID *

Major *

Phone # *

Email *

Graduation Term

IMPORTANT: If you will will not complete the required courses/hours until after Spring 2019 you will not be eligible to receive the Community Engagement Medal in time for the Spring 2019 Communty Engagement Awards and Commencement Ceremonies. You may still apply upon completion of eligible courses/hours beyond the Spring 2019 semester and receive the Community Engagement Medal upon qualification. Contact CICE on (657) 278-3746 if you have questions.

Eligible Coursework

Enter experiential learning courses that qualify you for the Community Engagement Medal. You can qualify by meeting all three criteria below:

1. Complete at least 2 allowed experiential learning courses (see list of allowed and disallowed courses here). Courses must have a minimum requirement of 20 hours to be eligible. Click "Add" if you did more than two experiential learning courses.

2. Hours for all experiences submitted must have been UNPAID ("Unpaid" is defined as below prevailing state-applicable minimum wage).

3. Demonstrate how you have gone above and beyond the experiential learning requirements for your degree by meeting one of the following criteria (select one):

Criteria 3 Qualification: *

You were not required to complete one or more of the courses to be entered below to graduate. Note: This will be confirmed by the CICE office.

You completed a minimum of 30 hours in excess of those required in one or across all courses entered. Total for "Actual Hours Completed" should exceed total for "Course Minimum Hours Required" by at least 30.

Course Title (eg. CAS 494)*	Semester*	Year*	Course Minimum Hours Required*	Actual Hours Completed*	Site Name*	Was this position paid?*
Course Title (eg. CAS 494) *	Semester *	Year *	Course Minimum Hours Required *	Actual Hours Completed *	Site Name *	Was this position paid? *
Course Title (eg. CAS 494)	Semester	Year	Course Minimum Hours Required	Actual Hours Completed	Site Name	Was this position paid?

Hours Completed *

At the time of submission, I have completed all the hours required to qualify for the Community Engagement Medal:

Yes

No (I still have hours to complete)

File Upload: Supervisor Letter *

If you have yet to complete the hours required to qualify for the medal, but will complete them this semester, please upload a letter from your supervisor stating that they will ensure the hours required will be completed by the conclusion of the semester. Please have your supervisor use the sample letter at link below as a template. You can email the link to the sample letter to them directly (right click > copy hyperlink).
More information

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png pdf.

File Upload: Proof of Hours *

If you met requirements for the Community Engagement Medal by completing the 30 hours more than required option, you must upload copies of your time sheets or a letter from your supervisor documenting the additional hours here. Time sheets or letters must be clearly legible and be signed by a supervisor. See below for links to examples which you can share with your supervisor. Image files and PDFs acceptable.
More information

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png pdf.

File Upload: TDA *

Please upload a copy of your Titan Degree Audit or Unofficial Transcript.
More information

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png pdf.

Sample Documents:

Proof of Hours Timesheet

Proof of Hours Letter

Hours in Process Supervisor Letter

All necessary Application Check-list items (below) must be received by the Center for Internships & Community
Engagement (CICE) no later than 5pm on Friday, March 22, 2019. Late or incomplete applications WILL NOT be accepted.