Form

Faculty Name*

First Name Last Name

E-mail*

Date Submitted*

Course Number*

Course Name*

If applying for multiple classes, please list additional course numbers and names (ex: ENGL 2025, Fiction; ENGL 2000, English Comp)

College*

Department*

Department Chair*

Department Chair E-mail*

Maximum Course Enrollment*

Will participation in the service-learning portion of the course be required or optional?*

Required Optional

Do all sections of this course have a service-learning option?*

Yes No

I am seeking service-learning credit for:*

the course as approved when taught by the faculty member named above

If service-learning credit is sought all times course is offered as proposed, explain what will be done to ensure appropriate faculty preparation to maintain the integrity of the course.

Name and contact information for community partner(s). If your community partners change regularly, please provide a general description as to who your partners usually are and detailed information about how you choose the partners each semester and identify the community need.*

What is the community-identified need(s) that will be addressed by this class?*

How will the reflections connect to course content, or will students be simply reflecting on experiences?*

How will you determine the degree to which the community need has been addressed?*

How will you determine if the students have made connections between the service-learning experience and the course content?*

If graduate assistants or others are helping to monitor the service projects, what training will they receive to facilitate this service-learning course component?

Please attach your syllabus, which should include a) explanation of the types of S-L experiences used to meet course objectives b) how students will make contact with the community partners c) a description of the reflection component used to connect the service experience and course goals d) estimated number of hours that students will serve in the community e) explanation of or link to risk management policy.*

To submit additional information or attach multiple syllabi, please use the buttons below.

Attachment 2

Attachment 3

Attachment 4

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LSU CCELL Service-Learning Designation Application