Service Learning HawCC
Name of Agency/Organization_______________________________________________
Name of contact person ___________________________Title_____________________
Phone # ____________________Fax # ________________ email __________________
1. Describe the services your organization provides:
2. Describe the type(s) of duties that students can perform for you:
3. How many service learning hours are you requesting?
_________/week __________/month __________/semester
4. Which times are best for students to participate?
____mornings ____afternoons ____evenings ____weekends
Indicate specific times if necessary:
5. How many students can you effectively work with each semester? _______
6. Do you provide an orientation for new participants? ______YES ______NO
7. Do you provide training for participants? ______YES ______NO
8. Do you provide on-site supervision? ______YES ______NO
9. Are you willing to write an end-of-semester assessment if requested?