ࡱ> bea ; bjbj$$ 8ZF|F|B:::::NNN8N+>7+9+9+9+9+9+9+$-0]+:]+::r+wwwF::7+w7+ww)|*p%T^)#++0+)21=21$*21:*w]+]++21 : Service-Learning Hours Log Form & Evaluation of Performance by COMMUNITY SITE SUPERVISOR Section 1 To be completed by the student Student nameTelephone & emailInstructors nameCourse Number & SectionCommunity Service SiteCommunity Site Supervisor NameNumber of required hoursSection 2- To be completed by Community Partner/Site Supervisor Agencies may return the completed form to the Center for Civic Engagement by mail or may give it to the student to deliver to the Center for Civic Engagement. Date(s) of ServiceHours servedStudents Performance Rating ExcellentGoodSatisfactoryPoorOverall quality of service Willingness to workCooperative attitudeWorked well with othersAcceptance of supervisionTook initiativeCourteous behaviorDependabilityTOTAL HOURS SERVED:Punctuality and attendance. (Did the student call if late or absent?)Comments: Community Partner/Site Supervisors Name (Please Print) Service Site Phone NumberSupervisors Signature Date     1501 State Street, Marshall MN 56258 Phone: 507-537-6423 Fax: 507-537-6115 Faculty Coordinator: Christine Olson, Ph.D. XY . 4 L m n    L m n q ̶̗̈||j[jIj|"h*qh~rU5CJOJQJ\aJh~rU5CJOJQJ\aJ"h*qh~rU5CJOJQJ\aJh~rUCJOJQJaJh*qh~rUCJOJQJaJh~rUCJOJQJaJ%h~rU5B*CJOJQJ\aJph"+h*qh~rU5B*CJOJQJ\aJph"h*qh~rUCJOJQJaJ#h*qh~rU5CJOJQJ^JaJ#h~rUh~rU5CJOJQJ^JaJY$If]^gd $Ifgd7 ($d%d&d'd-DM NOPQ](gd~rU$dd-D`M [$\$a$gd~(~~ $Ifgdxkd$$Ifl0 (> 04)64 layt~~ $Ifgdxkd$$Ifl 0 (> 04)64 layt~~ $Ifgdxkd,$$Ifl0 (> 04)64 layt~~ $Ifgdxkd$$Ifl0 (> 04)64 layt  ~~ $IfgdxkdJ$$Iflh0 (> 04)64 layt  ) * ~~ $Ifgdxkd$$Iflh0 (> 04)64 layt* + , - ~~ $Ifgdxkd$$Ifl0 (> 04)64 layt- . n  ! . / PKK??? $$Ifa$gdgd~rU7 :$d%d&d'd-D M NOPQ]gd~rUxkd!$$Ifl0 (> 04)64 layt/ K L V [ h m $$Ifa$gdm n kd$$Iflִ^ dP<#(                       04)    4 laytn o p q $Ifgd kd $$Iflִ^ dP<#(                         04)    4 layt $Ifgd    ( : ; C P Q V k l ! " ? @ A B C E F H I K L N O P Q R S T Y 񞚒zh g7CJOJQJaJhmbh g7hj.djhj.dUhmLh*qh~rUOJQJh~rUCJOJQJaJh*qh~rUCJOJQJaJ"h*qh~rU5CJOJQJ\aJh~rUCJOJQJaJh*qh~rUCJOJQJaJh*qh~rUCJOJQJaJ0 kd,$$Iflִ^ dP<#(                         04)    4 layt $Ifgd kdN$$Iflִ^ dP<#(                         04)    4 layt $Ifgd kdp $$Iflִ^ dP<#(                         04)    4 layt  $Ifgd kd $$Iflִ^ dP<#(                         04)    4 layt    ! " # $ $Ifgd$ % kd $$Iflִ^ dP<#(                         04)    4 layt% & ' ( ; < = > ? $Ifgd? @ kd $$Iflִ^ dP<#(                         04)    4 layt@ A B C Q R S T U $IfgdU V kd $$Iflִ^ dP<#(                         04)    4 laytV b j k l $$Ifa$gd $Ifgd kd$$Iflִ^ dP<#(                     04)    4 layt $Ifgd kd<$$Ifl ִ^ dP<#(     04)    4 layt   ! akdp$$Ifl(")04)4 layt $Ifgd! " 9 : ? $Ifgdtkd$$Ifl0l(\04)4 layt? @ A B D E G H J K M N O P Q gd~(tkd|$$Ifl0l(\04)4 laytQ R S T 2 3 4 5 6 7 8 9 : ; gdwch]hgdwcY [   2 3 5 6 7 8 9 : ; hmLhj.dhmbh g7h'Sh g7CJOJQJaJh'SCJOJQJaJhUh'SCJOJQJaJ6&P1h:p\4/ =!"#$% $$If!vh#v> #v:V l04)65> 5/ 4yt$$If!vh#v> #v:V l 04)65> 54yt$$If!vh#v> #v:V l04)65> 54yt$$If!vh#v> #v:V l04)65> 54yt$$If!vh#v> #v:V lh04)65> 5/ 4yt$$If!vh#v> #v:V lh04)65> 5/ 4yt$$If!vh#v> #v:V l04)65> 5/ 4yt$$If!vh#v> #v:V l04)65> 5/  / / /  4yt $$If!vh#v#v#v#v #v#v#v:V l04)5555 555/  /  / / /  /  4yt $$If!vh#v#v#v#v #v#v#v:V l04)5555 555/  /  / / /  /  4yt $$If!vh#v#v#v#v #v#v#v:V l04)5555 555/  /  / / /  /  4yt $$If!vh#v#v#v#v #v#v#v:V l04)5555 555/  /  / / /  /  4yt $$If!vh#v#v#v#v #v#v#v:V l04)5555 555/  /  / / /  /  4yt $$If!vh#v#v#v#v #v#v#v:V l04)5555 555/  /  / / /  /  4yt $$If!vh#v#v#v#v #v#v#v:V l04)5555 555/  /  / / /  /  4yt $$If!vh#v#v#v#v #v#v#v:V l04)5555 555/  /  / / /  /  4yt $$If!vh#v#v#v#v #v#v#v:V l04)5555 555/  /  / / /  /  4yt $$If!vh#v#v#v#v #v#v#v:V l04)5555 555/ / / / /  /  4yt2$$If!vh#v#v#v#v #v#v#v:V l 04)5555 555/ / / / / /  / 4yt}$$If!vh#v"):V l04)5")4yt$$If!vh#v#v\:V l04)55\4yt$$If!vh#v#v\:V l04)55\4yt^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH \@\ ~rU Heading 2$<@& 56CJOJQJ\]^JaJN@N ~rU Heading 5 <@&56CJ\]aJDA D Default Paragraph FontRi@R  Table Normal4 l4a (k (No List 22 vtextdd[$\$:B@: 0 Body Text CJOJQJ>P@> 0 Body Text 2 CJOJQJ4@"4 wcHeader  !4 @24 wcFooter  !6U`A6 wc Hyperlink >*B*phdoRd ~rUDefault1$7$8$H$-B*CJOJQJ^J_HaJmH phsH tH PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] ;Z  Y ; , * - / m n $ % ? @ U V ! ? Q ;   !"#$%&'()*+8@0(  B S  ?BDEGHJKMN9<BDEGHJKMN9<33ABBEENY{59<@@ABBDEEGHJKMNY59<5FSM Fh$f_DFk_A:eZł^k`ܞ~h hh^h`OJQJo(h 88^8`OJQJo(oh ^`OJQJo(h   ^ `OJQJo(h   ^ `OJQJo(oh xx^x`OJQJo(h HH^H`OJQJo(h ^`OJQJo(oh ^`OJQJo(h hh^h`OJQJo(h 88^8`OJQJo(oh ^`OJQJo(h   ^ `OJQJo(h   ^ `OJQJo(oh xx^x`OJQJo(h HH^H`OJQJo(h ^`OJQJo(oh ^`OJQJo(h hh^h`OJQJo(h 88^8`OJQJo(oh ^`OJQJo(h   ^ `OJQJo(h   ^ `OJQJo(oh xx^x`OJQJo(h HH^H`OJQJo(h ^`OJQJo(oh ^`OJQJo(h^`OJQJo(hHhpp^p`OJQJ^Jo(hHoh@ @ ^@ `OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHhPP^P`OJQJ^Jo(hHoh  ^ `OJQJo(hHh hh^h`OJQJo(h 88^8`OJQJo(oh ^`OJQJo(h   ^ `OJQJo(h   ^ `OJQJo(oh xx^x`OJQJo(h HH^H`OJQJo(h ^`OJQJo(oh ^`OJQJo(h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH5$f_:eSM^kk_                                                      ! Y wc~( +q!4 g7s=9KmL~rU'_mbj.di z\4{gW'SUT"VV0Kvp(BD@;@Unknown G*Ax Times New Roman5Symbol3. *Cx Arial9GaramondA. Trebuchet MSM  NBAOBD+ArialArial?= *Cx Courier New;WingdingsA$BCambria Math"hR$R$!24@@3qHP ?v2!xx Service-Learning PacketCivic Engagement smsuadmin$      Oh+'0Tx    (4<DLService-Learning PacketCivic Engagement Normal.dotm smsuadmin2Microsoft Office Word@@\\T@\\T՜.+,0$ hp  (ÿմ@ Service-Learning Packet Title  !"#$%&'()*+,-/012345679:;<=>?@ABCDEFGHIJKLMNOPRSTUVWXZ[\]^_`cdgRoot Entry F%TfData . 1Table8V1WordDocument 8ZSummaryInformation(QDocumentSummaryInformation8YMsoDataStore%Tp%TMX0F3WUO2Q10==2%Tp%TItem  PropertiesUCompObj r   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q