Co-Curricular Service-Learning Proposal Form

This document cannot be saved. Before you begin:

  • Consider the Criteria for a co-curricular service-learning experience to qualify for an Engaged Learning graduation requirement.
  • Be sure to have all the information to complete all the fields, including a detailed description of your project.
  • Review the Online Reflection Form to help you be intentional and get the most out of the experience.
  • Return to Co-Curricular Service Learning requirements

**Enter all emails correctly. Incorrect email addresses will result in an incomplete proposal.

Student Name:
Student ID:
Student Campus Email:
Student Phone Number:
Year in School:
Student Expected Graduation Date:
Academic Advisor
Academic Advisor Email
Project Supervisor (This is the person you report to on your project or who advises your organization):
Project Supervisor Email
Brief description of co-curricular service-learning activity and title of your position if applicable:
Timeframe that service-learning activity is taking place:

Start Date: (dd/mm/yyy)

End Date: (dd/mm/yyy)
Who is your main community partner (Drury can be your community partner if you are serving the University)?
Who will benefit/who are you serving?
In a paragraph or more, please tell us how you hope to benefit from this experience?

What are the main community issue(s)  you will be addressing?  Check all that apply:

Animal Welfare
Arts
Disaster Response
Domestic Violence
Education
Environmental
Health Care
Human Rights
Hunger
Poverty
Philanthropic/Fundraising
Senior Citizens
Special Needs/Disability Support
Underrepresented Groups
Youth
Other (specify)
 
In a sentence or two, please identify learning objectives for each of the following questions:
1. Personal: What do I hope to learn about myself?
2. Group: What do I hope to learn about others?
3. Community: What do I hope to learn about the community?
4. Community: What impact do I hope to have on the community?
In a paragraph or more, how will you know you made a difference?
Clearly list your expected roles/responsibilities:
   

By checking this box, I understand that I am responsible for getting signatures and ensuring that the course gets added to my schedule.  To be eligible to receive credit, I must complete the Service-Learning Reflection form after I have completed my project.
 
  You should receive a confirmation email confirming your submission.   If you do not receive email confirmation, your proposal did not go through.  Contact Web Communications at web@drury.edu with technical difficulties.