Service-Learning Notification Form

Admin Info

Form category

Other

Please complete this form if you are teaching a service-learning in the current or upcoming semester.

Name *

Email *

Class *

Class Section (if known) *

Semester teaching *

Select the semester you will be teaching this class.

# Service Hours required *

This is the number of service hours each of your students will be required to complete in your class.

Service-Learning Optional *

Which of the following best describes the student service components of your class?

Required

Optional (alternative assignment available)

Extra Credit

How will your students find service opportunities? *

I will provide a list of CICE-approved service opportunities

Students will find opportunities through Titan Connection

Students will find their own opportunities and have them approved through CICE

Partner Sites
Please provide site contact information and a brief description of the service opportunity that your students will engage in with this community partner. Description should include a list of the activities and tasks the student will engage in during service with this partner. This description will be shared with your partner site contact. They will have the opportunity to add additional information about student activities in their response. Minimum 200 characters.
Organization Name*	Contact Person Name*	Contact Person Email*	Contact Person Phone Number*	Will students serve in the same position at this site as previous semesters?*	Description of service activities*	Remove action
Organization Name *	Contact Person Name *	Contact Person Email *	Contact Person Phone Number *	Will students serve in the same position at this site as previous semesters? *	Description of service activities *

Syllabus

If you are able to, please upload a copy of your class syllabus. Though this is not required, it is helpful to CICE as a reference and for when we must compile data about our campus service learning activities.
More information

Files must be less than 2 MB.
Allowed file types: doc docx odt.