Service Learning Course Form

This service learning data sheet will assist the Volunteer and Service Learning Center in assisting and providing resources for courses with service learning components at The University of Texas at Austin. Our service learning program works to promote and support service learning across all colleges and disciplines at UT.

Contact Information
Instructor's First Name
Instructor's Last Name
Title
Department
Preferred Method of Contact	Email Office Phone Cell Phone Fax Other
If 'Other', please explain
Course Information
Course Number
Course Name
What is your reason for incorporating service learning into your course?

Course Learning Objectives: Please List

Major Assignments: Please List

Optional: Other relevant information about course that would help in creating a service learning component:

Technical Assistance Desired From VSLC (PLEASE CHECK ALL THAT APPLY)
Assistance pertaining to:	Integrating service learning into course matching Provost criteria In-class presentation Referral to service site(s) Sample syllabi for similar courses Other
If 'Other', please explain
Resources pertaining to:	Risk management issues/liability Reflection activities with students Research on service learning Planning and preparation Philosophy of service learning Information on conference and workshops Other
If 'Other', please explain
Please list types/names of agencies with which you would be interested in working if known)

Questions About Form? Contact Lanese Aggrey, Director of Academic Service Learning.

(FORM ADOPTED WITH PERMISSION FROM FLORIDA STATE UNIVERSITY)

Updated June 08 2010

Comments to Diversity Web
Accessibility • Privacy

Service Learning Course Form

Contact Information

Course Information

Technical Assistance Desired From VSLC

Please list types/names of agencies with which you would be interested in working if known)