Instructor’s Name
Date
SERVICE LEARNING COUNCIL
CHECKLIST
Members of the Service Learning Council use this form to evaluate whether the
course design proposed by a faculty member does in fact qualify as a Blinn Service
Learning Course
Project is based in Service Learning methodology. Comments:
Preparedness (issues for student preparedness are included)
Academic Preparedness
Cultural Competency Preparedness
Yes
Yes
No
No
Action (the interaction with the community is linked directly to the
curriculum and desired student outcomes for the course)
Yes
No
Reflection (components that facilitate student reflection are built
into the project)
Yes
No
Recognition (appreciation/in-class event that marks the Service
Learning project ending in some manner)
Yes
No
Evaluation (a suitable assessment tool is in place that directly links
to the curriculum and desired student outcomes for the course)
Yes
No
Signed Agency Agreement with Community Partner
Yes
No
In Progress
Service Learning Component is Optional
Yes
No
Evaluation Tool is Suitable
Yes
No
Project in Compliance with Master Syllabus
Yes
No
Chairperson Support Status Form included
Yes
No
Course Approved
Yes
No
Service Learning Council Member’s Name ________________________________________________