College of Southern Nevada Education Department - Community Service Component -EDUC 201, 202,8 208 (702) 651-4400 4 a the difference in the Las Vegas community, when you become a part of it! ‘Whether soaking employment with a local education ageney, epplying for an edu- Catan scholarship, or writing @ proposal for ‘grant funding, i important thet an epplicant show a commitment to their community. The ‘common service component! of your lniro- ducory class ot CSN gives you the apport rity to build upon your existing community service commitment, or set the foundation For ‘many future years af meking our town grea. As a matter of fat, sttses show that mot! teachers, begen thinking abou! educcr ion as @ career ofer volunteering in some cepociy with local schools, religious groups, ‘or community organizations Your community srvice can be used in this closs to supplement, or oft some of your mendatory CSN Field Observaiion re- ‘quirements fer EDUC 201, 202, oF 203, How it works. Just se this form to ddocumant your hours of commuily servic, Your insirucior will provide you with details of how this service wil specifically be used as 0 ‘componant of his or hee lass. Follow up any service with @ request from the project coor, Evert of Project Nome: Your Nem (orn) Teel Hours/ Datel] Supervisor Nam (prin): Supervisor Signature: 2e So dinator fo provide you with tome sort of documentation that substantiates your in volvement. This can be «later of recognition, corficete, 2 photo, or anything ele thot corres tho orgorization's logo and authent- cates your portcipation. ‘Thanks for being pert of our college, ond pat of our communi, Ba CSN COUEGE OF SOUTHERN NEVADA we ca Ase Ducan 02-28-2018 (2pm to]: 26pm Shay Smith lesmith 2B Dg rearhEDU 201, EDU 202, EDU 203 + Community Service: ‘Component which te student works in & volunteer sapacty at any orgonization tht wi llove volunteers, lane nat senves the bettonment of schol age cin in he community. This agency is one which student solic ene can obtaln verified ator of Daricipation or certificate rom the organization leadership ta documents thai participation ang sours of erect onco completed = Private School Service: The student must arenge contact and obtain writen permission tom the school’s administration prior 10 ‘istation, and must have an officer ofthe schoo! rowde signed verification upon schoa!lettemeza ot ‘tho type of service peered, end dation ote communty serve tothe seraat + Organized Field Trip: Your CSW insiructor may be able fo organize an education ‘based il to in which all members ofthe clase mast et other location, stead of sttencing class athe ragulst scheduled time to eam service cred. Students must fill but OSWs Foe! Tip Waiver and provide itt he instructor before taveling 1a a sponsored off-campus evant. Crecit hours and verication fr thie experience wile eternined by your instructor. + Other Service ‘The student can design an presen’ a unique sens crioxted ecucationa experience to tn nstructr. ‘Tne proposal must bein wring and soraed upon by \@ CSN student and GSW instructor prior to accumulation of hours YOU MAY NOT fist the school you chaso for your Feld Observation requestor any other OSD scoot as ‘he agency for this Servica Lesming Proposal. Why? First of al, tne 10 hours for Fold Obeervatin is independent of ‘he 10 bouts serving the cormmunity at snother agency. ‘Secondly, you have no idea what schoo! you wil evantustly be placed at tis me. Lastly, your evertusl cooperating {sacher may not give you pertission fo stay an extrs 10 hours Beyond the equiramants af the Fels Observeiion. “Ths 10 hours of Community Senice snot rlatetto tho 10 hours of COSD Field Ossenvtion, 32 DO NOT start cols caling eny COSD schoo! to ask permission to voluntser thee, Your Full Name (print): Asiey Alnged Decan Ageney/ Type of Service: oo Ve Date(s) Daiefs) Daie(s) Total Hours: Supervisor Name (print): Supervisor Signature ‘Supervisor Phone: Supervisor e-mail Agency/Type of Service: Date(s) Data(s} Date(s) ‘Total Hours: ‘Supervisor Name (print: ‘Supervisor Signature: Supervisor Phono: Supervisor e-mail Agsney/Type of Service Date(s) Date(s) Date(s) Total Hours: ‘Supervisor Name (print) Supervisor Signature: Supervisor Phone: Supervisor e-mal Waza US mins Eye “osahes ; ERIE ao ales @ Tne squancoyy ees -17 (4 10 minal ei neh Jertontes Pheors tel LO ruber J S 902 = 875-412 bs. sinith #43 GB banetGrmYour Fat Name: Asiniey A CSN Professor: Steven J. Seas eee Agency Name & Contact Person Three Square Agency Adres “Wa N. Pecos Rd Las Vegas NV 8 Agency Phone: (702) 644 -3663, Contact Person's erat: is Gmail. Col DIRECTIONS: Complete folowing 3 sections so that vour instructor and selected agency is atvara of your serve lezming requirement plan. NEED/PURPOSE: - Why is this service needed? How wil It hep the community? Three square is neececl of volunteer because every Weekend they Are givmg food away for those in anced. Having Volunteer will allow People to ke happy,and ve provide wah ems they reed ACTION: - What specifically will you be doing over the 10 hours? Doring my \OMovrg At three Square | with be Volunteering at the Three Square call center, Foca dist cilution, and helping pack UP food fel “ems ane pro cloce, OUTCOMES: - What positive impact will this service have on the community? What do | personally hope to gain from the experience? What evidence do | nead to collect from the agency/contect person to verify my participation? The postwe wmpact that the communay wil) have is Wappinss and love. l hope te gam a lot of expetience to help people who dons have a home, or who are in need. SIGNATURES: have rviwed this sence proposl at asorave 0 proceed. The service wt bean on -LL/22 anorexia cite) Studort: Asigtey Alagai\ Desan Enea cece Ate Ga Sinskh 202-75" gr ex Agency/Contact Person's Approval: Si ding CSN instructor Approval: Steve Sat