Service Learning Log (10 Hours) EDU 201, EDU 202, EDU 203 Participation Log: Complete (Combine) Service Learning components to equal 10 hours or more, Be sure to attach specific additional documents required for each type of service listed below. + Community Service: Component in which the student works ina volunteer capacity at any organization that wil allow volunteers, {and that serves the betterment of school age children in the community. This agency is one in which the student solicits and can obtain a veciied letter of participation or certificate from the organization's leadership that documents ther participation and hours of credit nee completed, + Private School Service: ‘The student must arrange contact and obtain writen ‘permission from the schools administration prior to vstation, and must have an ofcer ofthe schoo! provide signed verification upon schoo! ltterread of the type of service perormed, sna uration ofthe community serve the schoo. - Organized Field Trip: ‘Your CSN instructor may be able to organize an education based fila trip in which all member ofthe class meet at another location instead of attending lass at the regular scheduled time to ear service crett. Students must fi ‘out CSN's Feld Tip Waiver and provide it to the instructor before traveling to @ sponsored off-campus event. Crecit hours and verfeation for this experience will be determined by your instructor. + Other Service “The student can design and present a unique service ‘oriented educational experience to their instructor “Tne proposal must be in writing and agreed upon by the CSN student and CSN instructor prior to ‘accumulation of hours. ‘YOU MAY NOT lst the schoo! you chose for your Feld Observation request, or any othee CCSD school as. the agency for this Service Learning Proposal. Why? First Cf, the 10 hours for Field Observation i independent of the 10 hours serving the community at another agency. ‘Secondly, you have ne idea what schoo! you wil eventually ‘be placed at ths time. Lastly, your eventual cooperating teacher may not give you permission to stay an extra 10, hours beyond the requirements of the Field Observation. The 10 hours of Community Service is not related tothe 10 hours of CCSD Field Observation, 0 D0 NOT start cold caling any CCSD schoo! to ask permission to volunteer thee Your Full Name (prin: AbQa\ Halverson genoyrype ot SenceNQw Hor ens (quer for (nara fr Date(s) M/P/aoie Date(s) ALY /20l@ Date(s) Total Hours: Oo. Barbara Bidel | Supervisor Name (print) ‘Supervisor Signature: Supervisor Phone: ‘Supervisor e-mail: Agency/Type of Service: Date(s) Date(s) Date(s) Total Hours: ‘Supervisor Name (print): ‘Supervisor Signature: ‘Supervisor Phone: Supervisor e-mail Agency/Type of Service: Date(s) Date(s) Date(s) Total Hours: ‘Supervisor Name (print): Supervisor Signature: Supervisor Phone: Supervisor e-mail:Service Learning Pre-approval (10 Hours) Complete this form and submit to your CSN instructor before proceeding with your contact hours Your Full Name: CSN Professor : ‘Agency Name & Contact Person Agency Address: ‘Agency Phone: Contact Person's email: DIRECTIONS: Complete the following 3 sections so that your instructor and selected agency is aware of your service learning requirement plan. NEED/PURPOSE: - Why is this service needed? How will it help the community? 1 1 Thig sevee YS Needed to hele Shdends urho ovo Special NoedS, or who Struggle With arnw g disabilihes. ACTION: - What specifically will you be doing over the 10 hours? I will be puting math Class and 4 Computer class fo hole He Shdents. OUTCOMES: - What positive impact will this service have on the community? What do | personally hope to gain from the experienc? What evidence do need fo colect rm the agency/ontct person overly my barttipaton? > nig CKeevionce ili VID me oy 4g TL hove tat this foc if T hove shdents Wikh ferwe feacey, and tor Tess es Is in MY elassvoon, Special NLeas “SIGNATURES: have reviewed tis sence proposal and approve fo proceed. The service wit begin on P-L? / 1 D eporoximate cate) Student: higa | Ha \veiSer Agency/Contact Person's Approval: CSN Instructor Approval: