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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 The Types/Names Of Agencies With Whom You Would Be Interested In Working (If Known)


Questions About Form? Rather Contact The VSLC Directly? Email Glen Baumgart.


(FORM ADOPTED WITH PERMISSION FROM FLORIDA STATE UNIVERSITY)