Community-Based Learning Forms

Sylvania SS 215 | 971-722-4419 | FAX: 971-722-4959

The following forms are available for faculty, students, and site supervisors. Faculty, if you find these forms do not fit with your class assignment, please let us know and we will work with you to develop a different documentation method.

Community-Based Learning Agreement

Purpose

  • To clarify expectations and learning objectives.
  • To keep a record of students involved in Community-Based Learning.
  • To facilitate communications with community partners.
  • To promote safety and reduce risk.

Procedure

  1. Complete the Instructor section at the top of the Agreement; fill in the learning objectives for the service experience.
  2. Mark the due date by when students should return the completed agreement to you, usually two weeks after the start of the quarter. (Note: Some sites will not accept Community-Based Learning students after the second week of the quarter.)
  3. Copy both sides of the agreement to give to students.
  4. Have students read both sides of the Community-Based Learning Agreement in class, and go over the requirements with them. This is crucial for risk management. Ask the students to take the Agreement to the site and return the signed form to you by the due date.
  5. Please send originals or copies to the Community-Based Learning Office at SY SS 215 at the end of the term.

 

Photo Release Form

Purpose

  • This form is needed whenever PCC uses photographs of students or community members. It is a signed statement from the individuals in the picture that they allow the college to use their picture.

Procedure

  1. Prior to taking pictures, ask those present for permission.
  2. Once you have taken pictures, ask those who appear in the picture to sign a photo release.
  3. On the release (front or back) make some notes to identify the person in the picture (clothing, hair color, glasses, seated, standing, etc.)
  4. Please either email the pictures to your instructor or to the Community-Based Learning Coordinator.
  5. Please send originals of the form to the Community-Based Learning Office at SY SS 215.

 

Liability Waivers

Purpose

  • This form is needed whenever PCC students participate in an activity outside of the classroom. It is a signed statement from the individuals that they accept responsibility for risks associated with the activity.

Procedure

  • Prior to the activity or travel, ask students to hand in signed liability waivers.
  • After the activity, hold on to the signed forms for at least two years, or send them to the Community-Based Learning office for safe storage at SY SS 215..

 

Evaluation of Students by Site Supervisors

Purpose

  • To account for students’ successful completion of community-based assignments.
  • To provide faculty and students with feedback on their community involvement.

Procedure

  1. Complete the PCC Instructor section, including the due date (so that you will receive the form back before the end of the quarter).
  2. Copy the form (or one of your own) for students to take to their supervisors.
  3. Supervisors complete the evaluation form at the end of the quarter.
  4. Please send originals or copies to the Community-Based Learning Office at SY SS 215.

 

Evaluation of Sites by Students

Purpose

  • To assess students’ Community-Based Learning experience.
  • To develop a database of recommended Community-Based Learning sites.

Procedure

  1. Students complete the evaluation forms in class at the end of the quarter.
  2. Please send originals or copies to the Community-Based Learning Office at SY SS 215.