Pre-Service Learning Individual Placement Contract

Are you a BCC student who plans to engage in service-learning? If so, please complete the Pre-Service Learning Individual Placement Contract, agree to the terms of engagement, and click submit.

This service learning contract must be submitted before the end of the fourth week of classes or before you start your service placement if that is earlier.

Semester: Year:

Course Information:

Course:

example: PSY165

Section:

example: A2W

CRN

example: 15423

Instructor Name:

First Initial: Example: Zahm M.

Student Information:

Student ID:

a nine digit number beginning with 900

First Name:

Last Name:

Address:

City:

State:

Zip:

Phone:

Mobile:

Email:

Community Partner Placement Information:

Organization:

Department:

Address:

City:

State:

Zip:

First Name:

Last Name:

Title:

Phone:

Email:

Service-Learning Activity:

Please describe the activities you will undertake as part of your Service-Learning project

Describe your Service-Learning Activity:

Describe the type of activity your professor has assigned for your required reflection activity.:

Expected project span:

Start Date:

(MM/DD/YYYY)

Finish Date:

(MM/DD/YYYY)

Mutual Understanding:

Community Partner/Placement--We commit to the following:

To provide adequate information, orientation/training, supervision, feedback, and assistance for the Service-Learning student to enable him/her to meet the responsibilities of her/his service position and facilitate student growth and learning
To respect the skills, dignity, and individual needs of the Service-Learning student
To provide meaningful tasks related to the student's course and to her/his skills, interests, and available time
To provide appreciation and recognition of the student's contributions

Service-Learning Student -- I commit to the following:

To perform my expected activities to the best of my ability
To adhere to the community partner’s policies and procedures, including record-keeping requirements and confidentiality of organizational and client information
To be open to supervision and feedback, which will facilitate my academic and civic growth
To meet time and activity commitments or if I cannot attend, to provide adequate notice so that alternative arrangements can be made

The Instructor of the course listed above has approved this community partner placement and assigned the reflection activity.

I AGREE