SERVICE LEARNING STUDENT AGREEMENT FORM OFFICE OF STUDENT LEARNING INITIATIVES TROY UNIVERSITY To be completed and signed by the Troy University student, community agency supervisor and the Troy University Faculty Supervisor. This form outlines the duties and responsibilities of the student volunteer participating in service learning activities through coursework at Troy University. Please provide the following information: Student Student ID: Phone #: E-mail: Service-Learning Class (course # and title): Instructor: Community Agency: Phone # Agency Supervisor: Title: Phone # E –mail: The parties hereby agree as follows: Start Date of Service-learning: Final Date of Service-Learning: Scheduled Days/Times for Student to attend Service-Learning Site: Day Time Monday Tuesday Wednesday Thursday Friday Saturday Sunday Proposed Service-learning tasks and experiences: Academic learning goals for service-learning experience: The Student agrees to follow the Troy University Student Code of Conduct, as outlined in the Oracle and the Troy University Catalog and any organizational guidelines set by the community agency. The Student agrees to communicate regularly with the community agency, including giving at least 24-hours notice to the Community Partner Supervisor if unable to attend on any given day. The Student understands that participation in the Service-Learning activity, as detailed above, must meet academic standards set by course instructor and any course credit towards final grading must meet guidelines set by instructor. The Student understands and consents to the liability standards laid out in the Academic Service-Learning Liability Standards and Release Form as detailed at: http:www.troy.troy.edu/servicelearning/students The Community Partner Supervisor agrees to: o Communicate with the Student regarding the expectations and logistics of the service experience o Orient the Student to the mission and structure of the organization and train them on the service that needs to be done o Provide clear supervision to Student o Provide the necessary tools to complete tasks o Ensure a safe experience and an environment free of discrimination o Verify the Student’s Service-Learning Time Log and complete the Service-Learning Final Evaluation; Please Sign and Date: Student: Signature: Date: Community Partner Supervisor Signature: Date: Faculty: Signature: Date: Parent/Legal Guardian (in case the student is 19 years old or younger): Name: Signature: Date: STUDENTS: You must submit signed form to your instructor and to the Office of Student Learning Initiatives, 115 Eldridge Hall by September 3rd, 2010 to receive credit for the Fall 2010 semester.
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