Service Learning Site Confirmation




Service Learning Information First Name:

Last Name:

Email Address:

Service Learning Course:

Service Learning Instructor:

Name of Site Placement:

Date of Service:

Expectations Agreement

SERVICE LEARNER: I commit to the following:

  • To perform my respective duties to the best of my ability
  • To adhere to organizational rules and procedures, including record-keeping requirements and confidentiality of organization and client information
  • To be open to supervision and feedback which will facilitate service learning growth
  • To meet time and duty commitments, or if I cannot attend, to provide adequate notice so that alternative arrangements can be made
  • Return this form to my instructor ASAP
Agreed To:  I agree to the expectations

Initials here:

Date:






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