San José State University : Center for Community Learning & Leadership : Faculty/Campus Record of Service-Learning Placements

Faculty/Campus Record of Service-Learning Placements

To be completed by Service-Learning (SL) Faculty and submitted as an online form. All fields are required. Hard copy is acceptable to Center for Community Learning and Leadership (CCLL).

Semester:	Faculty Name:
Faculty Phone:	Faculty Email:
SL Course #:	Course Title:
SL Course Section #: (if applicable)
# of Course Enrollment :	Required SL Hours per student:

Has the student submitted a completed Student Service-Learning plan?

(These Plans are to be retained by the instructor for one semester for liability purposes.)

Yes
No

Are all students serving at CCLL recognized sites?

(Faculty and students can view recognized community partners on the CCLL website.)

Yes
No

If not, please list the name of the new site the student is serving at the space below.

Thank You for your compliance.

Undergraduate Studies

Center for Community Learning & Leadership

Email: community.learning@sjsu.edu

Clark Hall 203, Extended Zip 0246

Tel: 408.924.3540

Fax: 408.924.6962

San Jose State University : Center for Community Learning & Leadership

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Faculty/Campus Record of Service-Learning Placements

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