Instructor/Applicant

Mailing Address
Address (cont.)
City
State/Province
Zip/Postal Code

Work Phone

E-mail

Course (title, department and number)

Number of students you anticipate will take part in service-learning

Approximate number of hours each student will be engaged in direct service

Amount of grant funding requested (up to $200)

Provide a description of how service-learning will be incorporated into your class. This could include some or all of the following: a description of where the service component of the service-learning process will take place, what the nature of student service will be, how the service will be integrated with course goals and objectives, how reflection on the service experience will be integrated into the course.

Is there other information you would like us to consider in the evaluation of your application?