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NAME:

STUDENT ID:

EMAIL:

COURSE YOU ARE IN THAT OFFERS SERVICE LEARNING:

COURSE NUMBER

NAME OF INSTRUCTOR

COMMUNITY SITE WHERE YOU WILL DO SERVICE:

NAME OF SITE SUPERVISOR:

NUMBER OF HOURS YOU WILL COMPLETE FOR THIS COURSE:

BY INITIALING THESTATEMENTS, YOU ARE AGREEING TO THEM:

I will notify my supervisor 24 hours in advance if I will be absent (including Spring Break or if I choose to drop this class). If I am absent more than once, I understand I can be terminated from this position.

INITIAL

I will be responsible and respectful. I will keep information about clients, staff and students confidential. I also understand that a background check may be done by my community site.

INITIAL

Should a problem occur, I will speak first with my site supervisor about the issue as soon as it arises. If not resolved, I will contact the Service Learning Office with my concern.

INITIAL

I grant IHCC use of my photographs and written quotes for the purpose of documenting service learning.

INITIAL

STUDENT SIGNATURE: (BY SIGNING THIS DOCUMENT, YOU ARE AGREEING TO ALL THE ABOVE STATEMENTS AND HAVE INFORMED YOUR INSTRUCTOR OF YOUR COMMUNITY SITE CHOICE AND THEY HAVE APPROVED OF IT)