LCSC Service-Learning Project Form

Date:

Organization
Contact Person
Work Phone
E-mail
URL

What is the "title" for this service project?

Project purpose:

Specific tasks or activities:

How many students could be assigned to this job description in one semester?

What is the minimal hourly commitment for the semester?

Is this service practical for younger LCSC students?

Yes No

Is this service at least partially on-site at the agency so students have regular contact with agency personnel?

Yes No

What times can student serve at your organization? (Two ways to describe times.)

Morning
Afternoon
Evening
Weekend
All/Any

OR

List specific times for this service, if applicable (i.e.: first Wednesday at 6 p.m.).

Can students bring their children with them?

Yes No

If yes, what ages would be appropriate?

All
Under 10
Over 10

Please indicate any special requirements for this service project/activity.

Driver's License:

Yes No

Background check:

Yes No

Training:

Other:

Please list service orientation dates for this project (to reduce phone tag). 

Example: 2/6/08 3-4 p.m. Administrative Conference Room

Session One:

Session Two:

Thank you for you willingness to participate in service-learning.  A member of our staff will contact you soon.  If you have any questions please contact us at bjdurham@lcsc.edu.