INSTITUTE FOR CIVIC & COMMUNITY ENGAGEMENT

1600 Holloway Ave. HSS 206

San Francisco, CA 94132-4027

Tel: 415/338-6419

Fax: 415/338-0587

Community Service-Learning Profile /
Designation Request
Name: Click or tap here to enter text. / Rank: Click or tap here to enter text.
Department: Click or tap here to enter text. / College:Click or tap here to enter text.
Phone: (office) Click or tap here to enter text. / SF State Email: Click or tap here to enter text.
Course Information: Please Check All That Apply

Course Name, Prefix, & Number: Click or tap here to enter text.

Required for Major: ☐ Required for Lower Division GE: ☐ Required for Upper Division GE: ☐

Course Implementation Date: Spring 2017: ☐ Fall 2017:☐ Spring 2018: ☐

How often do you teach this course? ☐ Every Fall & Spring semester ☐Annually (one semester each year)

☐Other: Click or tap here to enter text.

Definition: Service learning is an academic pedagogical model that integrates action linked to relevant community service and structured reflection so that each reinforces the other. The academic study may be in any discipline. The service may address a variety of community needs.

Minimum criteria for designation of service learning courses:

  1. The course involves students in service activities or projects with external communities that are responsive to community needs. Students who choose the CSL option must complete at least 20 hours per academic term of direct academically relevant community service.
  2. The course includes academic topics that directly address questions related to the activities of the students.
  3. The course requires student reflection on the interrelationships between course content, concepts, and objectives and community-based learning activities.

NARRATIVE

Please respond to the following questions in the space provided or attached additional pages.

  1. Description of the probable service assignment(s), including specifics on work products expected and an explanation of how students will be prepared for their service placement.

Click or tap here to enter text.

  1. An explanation of how you will integrate learning from this particular community service learning experience into course discussion and assignments, including a statement of how learning from a service will be evaluated. Reflection techniques used in the course.

Click or tap here to enter text.

  1. Attached is my Course Syllabus (please check): ☐

4. # of CSL hours/semester: Click or tap here to enter text.

CSL STEERING COMMITTEE APPROVAL

Approved: ______Denied: ______

Page 1 of 2