Portfolio Part 1:
Service-Learning Plan
PSJS 250: Social Change through Service
Student Name: ___________________________ E-Mail: ________________________
Local Address: __________________________________________________________
Local Phone: ________________________Cell Phone: _________________________
Major: _____________________________
Service Site/Agency: ______________________________________________________
Site Supervisor: ___________________________Phone: ________________________
Address: _______________________________________________________________
Other Relevant Contact Information: ______________________________________
Beg. Date: __________________________ Approx. Ending Date: ______________
Volunteer day(s) and time(s)_______________________________________________
Motivation: Please identify and describe your motivation for choosing this particular agency,
population, and/or issue to work with. Include any relevant prior experiences, major interests,
and future goals that impacted your decision. Why does this service interest you?
Please attach a typed paragraph (single-spaced) in response to this question
Learning Objectives: Please describe your mutually agreed upon (with site supervisor)
learning objectives for your 10 weeks at this organization. Objectives may include what you
hope to learn about the agency, its clients, the issues, yourself, and connections with the course
work.
Please attach a typed paragraph (single-spaced) in response to this question
Service Objectives: Please identify and describe your mutually agreed upon (with site
supervisor) job tasks and/or activities and specific responsibilities that will be expected of you.
Describe other objectives that will help meet the needs of the agency and is clients as identified
by your supervisor. Service objectives should help you work on your learning objectives.
Please attach a typed paragraph (single-spaced) in response to this question
Service-Learning Plan Continued
PSJS 250: Social Change through Service
Project Ideas: Please describe your tentative project ideas after discussing them with your
supervisor. Include the needs of the project, its goals, and parameters. Briefly describe the nature
of the final product that will be given to the agency and presented at the end of the semester. It is
understood that these preliminary ideas may be revised.
Please attach a typed paragraph (single-spaced) in response to this question
Site Description: Please describe your agency/organization in terms of its mission, goals, staff,
clients, and culture. Supplement your description with brochures, newspaper articles, publication
materials, etc. which you can include in your portfolio.
Please attach a typed paragraph (single-spaced) in response to this question
________________________________________________
The Site Supervisor: Agrees to guide this students’ work, provide feedback to the student and
instructor when requested, and discuss any concerns about the service learner’s performance with
him/her directly and with the course instructor if necessary.
Site Supervisor Signature: ___________________________ Date: _________________
Student: Agrees to read the Service-Learning Assignment Handout, follow the guidelines and
expectations listed on this Handout, and follow the guidelines and expectations communicated by
your supervisor and/or agency staff.
Student Signature: ___________________________Date: ____________________
Course Instructor: Agrees to examine and approve this learning plan, communicate with the
site supervisor when needed, and provide support, feedback, and guidance to the student.
Instructor Signature: ___________________________Date: ___________________
Note: All responses to the above questions may be included on a single
document and stapled to this Plan.