ࡱ>  -bjbj 8c######7778od\7:>/(W: :::::::$<d?f):## ##):##>:O(O(O(#^##:O(#:O(O(7|_9 Bz7G$c89T:0:u8?%?$_9?#_9 !O(6""/ ):): 'B :####?  :  SMSU Faculty Service-Learning Packet (SL Agreement, Reflection, and Evaluation Forms) Center for Civic Engagement ÿմ  HYPERLINK "mailto:Civic.engagement@smsu.edu" Civic.engagement@smsu.edu Christine Olson, Ph.D. 507-537-6423 BA 239 Spring 2013 SMSU Service-Learning Agreement This form should be completed before students begin their service-learning project. Students are responsible for obtaining all signatures and providing one copy to faculty, the Center for Civic Engagement, and the Service-learning Site Supervisor by ________ (date determined by instructor of course). Students will keep the original. Semester/Year: Todays Date: Course Number and Title: Faculty: Community Partner/Site: ________ Community Partner/Site Supervisor Name:______________________________________________________________ Community Partner/Site Contact Information: Phone _________________ Email_______________________________ Address ____________________________________________________ Total Service-learning Hours Required: _______________________________________________ (hours) Start Date:____________________________________ End Date: ________________________________ Students Role: Be aware of the organizations needs and provide assistance where and when needed, fulfilling time and service obligations. Contact the agency to arrange initial meeting to discuss service-learning hours and project. (In some cases, instructor of course me make initial contact with sites.) Submit necessary paperwork: Service-Learning Agreement, Media Release, Service Learning Final Evaluation (Copies should be submitted to the Center for Civic Engagement, your Instructor, and the Community Partner/Site Supervisor. Student will keep original.) ) Adhere to organizational rules and procedures, including confidentiality of organization and client information. Periodically reflect upon and re-evaluate the service experience keeping in mind the objectives of all parties involved. Operate with integrity and professionalism at all times; which includes being punctual, meeting deadlines and being open to supervision and feedback which will facilitate learning and personal growth. Faculty Role: Provide students with structure and guidance to process and reflect upon service learning experiences. Assist students in connecting their service learning experience with course learning objectives. Participate in evaluation process. Community Site Supervisor/Organization Role: Provide service-learning opportunities that are significant and/or challenging to the students, relevant to course learning objectives, and address community agencys goals. Provide training, supervision, feedback, resources and sufficient information about the organization to aid in the success of students service-learning projects. Participate in the evaluation process. Center for Civic Engagement: Serve as a liaison between the organization, students, and faculty. Provide necessary contract/evaluation forms prior to beginning the service-learning experience and at its conclusion. Collect all paperwork, including: Service Learning Agreement, Media Release Form, and Service Learning Final Evaluation Form. Primary Course Learning Objectives Related to Service Project: Students complete. (Refer to your course syllabus for learning objectives.) 1.  2.  Other objectives: Primary Organization Service Objectives: Students complete with Site Supervisor service-learning supervisor. 1.  2.  Other objectives: Project Description (Defined by the Community Site Supervisor, Instructor and Students. Please describe the specific service role, tasks, etc. that the student will be expected to fulfill.) I have read and understand my role as outlined in this document. I commit to fulfilling my part of this service-learning partnership. I understand that this partnership is meant to further SMSU student learning and meet the community site/partner goals. INSTRUCTOR SIGNATURE COMMUNITY site/partner SIGNATURE CENTER FOR CIVIC ENGAGEMETN STAFF SIGNATURE STUDENT SIGNATURE Photographic and Video Release Form Thank you for taking part in this service learning project. Please acknowledge your permission for any video, or still photography made with your image and any sound recordings of your voice to be applied to a variety of uses by ÿմ . These might include, but not be limited to, uses such as in-house training of staff and students; images used on the universitys Internet Web Pages; documentarys for educational purposes; loan and/or sale to interested non-SMSU parties; cablecasting, broadcasting and other forms of electric transmission. I release to ÿմ, its staff, and representatives of and from any claims (monetary or otherwise) that I may have related to the images. I warrant to the University that I have read this Release and fully understand its terms. I have given permission for SMSU to use the media described above for the purposes indicated. Signature: ______________________________________________ Name Printed: ___________________________________________ Address: ________________________________________________ Date: ___________________________________________________ Service-learning Reflection Form (NOTE: This form should be completed mid-way through service-learning experience and submitted to your instructor. Your instructor will then submit reflection forms to the Center for Civic Engagement for evaluation purposes.) Describe the service activities that you are doing. How have you benefitted from your service experience personally and academically? What connections do you see between the content of the course in which you are enrolled (or previous courses you have taken) and the service activities you are doing? What have you learned about yourself from your service-learning experience? What was the most challenging thing that you have experienced so far? What did you learn from this experience? What changes would you recommend in how your service site operates and how the service-learning experience is structured? Rate yourself 1 (low) to 10 (high) for your performance. Why did you rate yourself the way you did? Service-Learning Hours Log Form & Evaluation of Performance by COMMUNITY SITE SUPERVISOR Section 1 To be completed by the student Student nameTelephone & emailInstructors nameCourse Number & SectionCommunity Service SiteCommunity Site Supervisor NameNumber of required hoursSection 2- To be completed by Community Partner/Site Supervisor Agencies may return the completed form to the Center for Civic Engagement by mail or may give it to the student to deliver to the Center for Civic Engagement. Date(s) of ServiceHours servedStudents Performance Rating ExcellentGoodSatisfactoryPoorOverall quality of service Willingness to workCooperative attitudeWorked well with othersAcceptance of supervisionTook initiativeCourteous behaviorDependabilityTOTAL HOURS SERVED:Punctuality and attendance. (Did the student call if late or absent?)Comments: Community Partner/Site Supervisors Name (Please Print) Service Site Phone NumberSupervisors Signature Date APPENDIX A: Service Site Lists and Databases In addition to possible service sites identified for your particular course, you may want to take advantage of the following additional resources for locating a service opportunity. Both of these resources provide information about one-time event and ongoing service experiences in the Marshall Area. SMSU Center for Civic Engagement Service Site Notebook (available in Center for Civic Engagement, BA239) SMSU Center for Civic Engagement Website United Way Volunteer Connection  HYPERLINK "https://volunteer.united-e-way.org/uwosm-4/volunteer/" https://volunteer.united-e-way.org/uwosm-4/volunteer/ Suggestions for approaching a service site: Introduce yourself as a student attending SMSU and enrolled in a service-learning course. Clearly state that the service experience will involve a requirement of 20 hours (or whatever your instructor determines) and ask if that time commitment is a good fit with the service site. Clarify your specific interests (i.e., what you would like to gain from the experience and why you are interested in their site). Ask if the would be willing to do the following: Sign a contract so that you, the site, your professor and the Center for Civic Engagement all agree to service-learning responsibilities and objectives (show contract agreement in Service-Learning Manual) Complete a one page evaluation/verification of completion of hours at the end of the experience (show evaluation form to be completed)     SMSU Center for Civic Engagement 1501 State Street, Marshall MN 56258 Bellows Academic Rm 239 Phone: 507-537-6423 Fax: 507-537-6115 Staff Coordinator:  HYPERLINK "mailto:Vindash.Chacko@smsu.edu" Vindash.Chacko@smsu.edu Faculty Coordinator: Christine Olson, Ph.D. Student Service Learning Assistant:  HYPERLINK "mailto:Angela.Euerle@smsu" Angela.Euerle@smsu  HYPERLINK "mailto:Christine.olson@smsu.edu" Christine.olson@smsu.edu ()*Z[\]vyɼ|l\L\5,jhVhV5CJOJQJU^JaJhVh5CJ(OJQJaJ(hVhv5CJ(OJQJaJ(hKh\45CJHOJQJaJHhKhv5CJHOJQJaJHhKhv5CJOJQJaJhKh05CJOJQJaJhKh 5CJ8OJQJaJ8hv5CJ8OJQJaJ8hKhv5CJ8OJQJaJ8hKh05CJ8OJQJaJ8h 5CJ8OJQJaJ8hv5OJQJ)*[\]z    # $ D E dpxgd0gd0$-D`M a$gdK$a$gd0$-D`M a$gdK$a$gdv    " # $ D M ~ ֳ풂ugYLBL8LYh0OJQJ^Jh\4OJQJ^JhfTh0OJQJ^JhfTh05OJQJ^JhKh05OJQJ^Jhon5CJ OJQJaJ hKhv5CJ OJQJaJ hVhV5CJOJQJaJ hmhmCJOJQJ^JaJhv5CJOJQJ^JaJ'hVhV0J5CJOJQJ^JaJ,jhVhV5CJOJQJU^JaJ#hVhV5CJOJQJ^JaJ   * 0 _ b n { ) 0 1 r Ŵ랖||o[&hwch05CJOJQJ\^JaJh05OJQJ\^JhwcOJQJh0OJQJaJhwcOJQJh0OJQJh0OJQJh0CJOJQJ^JaJ hfTh0CJOJQJ^JaJ4jhfTh0CJOJQJU^JaJmHnHuhfTh0OJQJ(jhfTh0OJQJUmHnHu | 0 1 z "'O & F7$8$H$gd0 h7$8$H$gd0 & F7$8$H$gd0 7$8$H$gd0dpgd0 dp7$8$H$gd0r x QxZƶrgrYYLrhV5OJQJ\^Jh{CJOJQJ^JaJhfTh0OJQJ hfTh0CJOJQJ^JaJ hwchwcCJOJQJ^JaJ hwch0CJOJQJ^JaJ!hwch056OJQJ]^JhfTh05OJQJ\^J)hwch05>*CJOJQJ\^JaJ&hwch05CJOJQJ\^JaJ hwc5CJOJQJ\^JaJQxZ_`bchik~ P7$8$H$gd0 7$8$H$gd0 & F7$8$H$gd0 h7$8$H$gd0  & F7$8$H$gd0 & F7$8$H$gd0Z[`acdhijk~ԳԟscVcEԳԳԳ hfTh0CJOJQJ^JaJh05OJQJ\^JhfTh05OJQJ\^JhfTh0OJQJ\^J:jhfTh05CJOJQJU\^JaJmHnHu&hfTh05CJOJQJ\^JaJ@jhfTh056CJOJQJU\]^JaJmHnHu hfTh0CJOJQJ^JaJ4jhfTh0CJOJQJU^JaJmHnHu# 7$8$H$gd0gd0 7$8$H$gd0 xx7$8$H$gd0 7$8$H$gd0)Ĵ|k]L@7@h0:OJQJhfTh0:OJQJ hfTh{CJOJQJ^JaJh0CJOJQJ^JaJ hfTh{CJOJQJ^JaJh{CJOJQJ^JaJ hfTh0CJOJQJ^JaJhfTh0OJQJaJ hfTh05OJQJhfTh{6OJQJ]^Jh{6OJQJ]^Jh06OJQJ]^Jh\4h0OJQJ]^J&hfTh06CJ OJQJ]^JaJ  uwxyGJ9:;<=ﴫ~t~fY~L?h~rU5CJOJQJaJhwc5CJOJQJaJhKhVOJQJ^JhoW"hV5OJQJ^Jh{OJQJ^JhoW"hVOJQJ^JhoW"hVOJQJhoW"hV5OJQJh~rU5OJQJhV5OJQJhVCJOJQJ^JaJ#hfTh0;CJOJQJ^JaJ4jhfTh0CJOJQJU^JaJmHnHu hfTh0CJOJQJ^JaJ#vxyFGHIJgdV -D`M gd~rU$-D`M a$gd~rU$a$gdV 7$8$H$gd09:;=^_BCwxyz{|}~$a$gdwcgdwc$-D`M a$gd~rU 7$8$H$gd0gdV=^_@C~F H 3!4!5!6!!!!!˼ڼڼڼڼڼڼsdN+h*qh~rU5B*CJOJQJ\aJph"h*qh~rUCJOJQJaJ#h*qh~rU5CJOJQJ^JaJ#h~rUh~rU5CJOJQJ^JaJ hfTh~rUCJOJQJ^JaJhyh05CJ OJQJaJ hwch{hwcCJOJQJaJh'hwcCJOJQJaJhwcCJOJQJaJhwc5CJOJQJaJhKhwc5OJQJ}~D E F G H I J K gdwc !2!3!4!5!6!!!!!|$If]^gd $Ifgd7 ($d%d&d'd-DM NOPQ](gd~rUdd-D`M [$\$^gd~rU 7$8$H$gd~rU$a$gdvgdwc !!!!~~ $Ifgdxkd$$Ifl0 (> 04)64 layt!! 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