Service Learning Pre-

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Complete this form and submit to your CSN instructor before proceeding with
your contact hours

approval (10 Hours)

Your Full Name: Ruby Perez

CSN Professor : Vicki L. Rieger

Agency Name & Contact Person Agency Address: Fay Herron Elementary School 2421 N Kenneth Rd
North Las Vegas, NV 89030
Agency Phone: 702-799-7123
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?

With this service I will be assisting in the homework club. I will be helping children in grades 1st and 2nd.
It will help students better understand their homework and class work. It will also help those students
whose parents are not proficient in math or writing or school in general. The homework club is also
giving those kids who can not go home right after school because their parents are working, it gives
them a place to be safe.

ACTION: - What specifically will you be doing over the 10 hours?

I will be tutoring 1st and 2nd graders. I will help them understand how to do their homework. I will be
helping another teacher. I will take control of half of the class and help them read and count. Most kids
are smart but they have trouble understating how to put their ideas down. I will be there to guide each
student into the right pathway.

OUTCOMES: - What positive impact will this service have on the community? What do I personally
hope to gain from the experience? What evidence do I need to collect from the agency/contact person
to verify my participation?

This service will help students understand their homework better. It will help them receive better
grades in class and make them feel proud of themselves. I hope to learn many things while being there.
It will help me better understand how kids think and what troubles they have. It will show how
differently each kid is and the ways that they learn. Tutoring is an hour. I would need to go in and
finish the hour and get my paper signed by the supervisor and have her/him write down their contact
information where they can be reached.

SIGNATURES: I have reviewed this service proposal and approve to proceed. The service will begin on
__________________ (approximate date)
Student:
Agency/Contact Person’s Approval:

CSN Instructor Approval:

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