Last Name
First Name
E-mail Address______________________ Service Start Date ______________End Date ___________
Please note: the dates listed about are the actual dates for the course. Details for actual service learning
hours will be arranged by both parties and implemented within the contract once agreed upon.
Agency Name ___________________
Course Number
Site Contact__________________ Phone #_____________________
Phone #_______________________
Brief Description of Service:
What is Service-Learning?
“Service-learning is a philosophy of experiential learning [integrated into and enhancing academic curriculum] in which
students participate in community service not only to meet the needs of the community, but also to develop their critical
thinking skills, commitment to values, and skills for effective leadership.”
Mintz & Liu, 1994
The Service-Learning Agreement is designed to:
♦ Assist the student and agency in understanding the learning objectives for the course.
♦ Clarify the activities in which the student will be involved at the agency in relation to the
learning objectives.
♦ Ensure that both the student and the agency are aware of the responsibilities as partners in
this service-learning project.
Part I: Learning Objectives: (To be filled out by the student)
Course Objectives:
Please list the learning goals provided by the instructor for this course that will be met with this project.
Student’s Personal Learning Objectives:
Please describe three learning goals for your work at this agency. These should relate to the course goals provided by your
instructor and to your own personal experience and development.
Part II: Agency Activities: (To be filled out by community agency supervisor)
Please describe the work that will be completed during this service-learning project and how it contributes to the agency.
Part III: Integration Plan:
How will you (student) connect your activities in the agency to your course content and vice versa?
Part IV: Responsibilities:
As a service learner I agree to:
Attend an orientation at my site and serve the agreed upon time for the duration of the semester
Call my site if I am unable to make my normal scheduled time
Act in a professional manner when attending my site
Fill out and return paperwork within designated timeframe
o Notify my site contact if I am having problems with my site, or notify my professor if problems cannot be
resolved by talking to the site contact
Keep track of my hours throughout the semester on the approved service learning timesheet
Student Signature
As a community partner with the Service Learning Project at UCO I agree to:
Provide a thorough orientation and discuss learning objectives with service learners
Place students in volunteer situations which will be complementary to their class work
Be available to the service learners to let them know of things such as agency calendar and special events
Provide feedback on the service learner’s performance
Site Contact Signature
As a professor using service learning I agree to:
Review contract to insure course objectives and service activities are appropriately matched
Provide guidance to help students relate their volunteer experience to their class work
Check in with students to make sure service experiences are going well
Communicate with the community partner during the semester
Help students reflect on their service and societal issues they encounter
Professor Signature
Make three copies of this form when complete:
1. Student
2. Agency/organization supervisor
3. Professor
Created April 2014 by
Dr. Lori Risley
Assistant Professor, Service Learning Scholar,
Adult Education & Safety Science Dept.
University of Central Oklahoma
100 N. University Dr., Box 120, Edmond, OK 73034
[email protected] 405-974-5533
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