Service Learning Program
444 W. Third St., Room 6141 SINCLAIR COMMUNITY COLLEGE
Dayton, OH 45402 SERVICE LEARNING
(937) 512.2040 TRACKING & EVALUATION FORM
(937) 512.5015 (fax)
Please collect and send the following information to Marilyn Rodney,
email@example.com, or mail completed form to Room 6141. Information
must be received by the end of the quarter for departmental reporting.
COURSE NAME COURSE -SECTION NUMBER INSTRUCTOR NAME QUARTER/YEAR
(EXAMPLE ‘CIS’) (EXAMPLE ‘278-05’)
AGENCY NAME PROJECT NAME EMAIL ADDRESS
LEARNING OBJECTIVES FOR USING SERVICE LEARNING. PLEASE BE SPECIFIC.
NUMBER OF STUDENTS WHO PARTICIPATED HOURS PER STUDENT SPENT ON PROJECT
(MAKE SURE TO TURN IN YOUR STUDENT AGREEMENTS) (INCLUDING PREP TIME)
STUDENT OUTCOMES. PLEASE BE SPECIFIC. INCLUDE MEASURABLES. (EXAMPLE ‘SERVED 120 MEALS TO HOMELESS’, ‘SERVICED
60 HEATING SYSTEMS FOR LOW INCOME INDIVIDUALS’, ‘ORGANIZED PARTY FOR 30 CLIENTS WITH GAMES, DANCING, FOOD, & DOOR
PRIZES’) INCLUDE WHAT YOU USED AS A REQUIRED ASSIGNMENT (PAPER, PRESENTATION, ETC.) THAT LINKS LEARNING TO
YES, I HAVE PHOTOS FOR THIS PROJECT THAT I WILL FORWARD TO YOU.
YES, PHOTOS FOR THIS PROJECT ARE ATTACHED.
NO PHOTOS ARE AVAILABLE FOR THIS PROJECT.
INSTRUCTIONS FOR STUDENT SERVICE LEARNING
Prior to beginning a Service Learning project, each student must complete a Student Agreement which
addresses liability and risk management issues.
If the project is selected on line, the student does not have to forward a copy of the Student Agreement to
the Service Learning Office.
If the project is not selected on line, the student must forward a copy of the Student Agreement to Service
Learning, Room 6141.
If you or your students would like the benefits of Work Force Development (Real Life Experience), and
documentation for Student Portfolios, Students may complete and retain a copy of the Site Evaluation
Hours Log Form. You do not have to forward a copy of this form to Service Learning.
TO FACILITATE MARKETING OF YOUR COURSE AND USE OF SERVICE LEARNING
Please submit the following:
Tracking and Evaluation Form (on reverse side of these instructions).
Sample reflections, writing assignments, etc. from students.
Sample student stories and comments related to their Service Learning.
Copy of course syllabus that includes the description and required assignments related to Service Learning.
To create posters for display throughout the campus highlighting your course and Service Learning project.
To report College Department and Division Service Learning and Student Learning opportunities.
Let me know if I have your permission to post your syllabus on the National Service Learning web site as an
example of how Service Learning can be integrated in a specific course.
THE FOLLOWING SERVICES ARE AVAILABLE TO YOU
PLEASE CONTACT MARILYN RODNEY FOR SCHEDULING AND DETAILS
Training of all types including individual, group, faculty and community partners.
In class Service Learning orientations for your students.
Distribution and collection of all Service Learning forms.
Assistance in identifying Service Learning Community Partners and projects.
Service Learning reports for course, department and/or division.
Locating sample Service Learning syllabi, literature resources, conferences, and publishing opportunities.
Assistance in developing multidisciplinary Service Learning projects.
Identifying funding opportunities for Service Learning.
Letters to Chairs/Deans recognizing your contribution to Service Learning.
Annual Recognition Celebration, certificates, and posters highlighting your Service Learning projects.
* Engage Your Mind * Serve Your Community * Change The World * Be The Difference