Portland Community College | Portland, Oregon Portland Community College

Forms

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.

Before filling out any forms that are available as PDF files, download and save to your computer first. 

Learning Agreement

Individual Student Learning Agreement

  • Go Paperless! Please contact CBL Program Coordinator to set up an online form for your course.

Group Project 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 for Instructors
  1. Download and save the PDF to your device (must do this before filling out any fields).
  2. Complete the Instructor section at the top of the Agreement; fill in the learning objectives and required impact for the community engagement experience.
  3. Mark the due date by when students should return the completed agreement to you. Student should return form prior to community engagement experience for review and approval by the instructor.
  4. Distribute to students as a printed copy or share electronic PDF.
  5. 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 Community Partner and return the signed form to you by the due date.
  6. Please send electronic copies to the Community-Based Learning office at the end of the term.

Photo release

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.

Liability waivers

Release of Liability Adult (pdf)

Release of Liability Minor (pdf)

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 for Instructors
  • 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.

Supervisor Evaluation

Individual Student Evaluation
Student Group Evaluation

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

Student Evaluation

Student Project Site Evaluation

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.

Faculty Recognition

Faculty Nomination (Online Form)

Purpose
  • Every year the CBL Program recognizes faculty who have demonstrated a deep commitment to community-based learning through their dedication to CBL best practices, commitment to community responsibility, and/or commitment to high academic rigor.
Procedure
  1. Submit nomination form.
  2. Awardees will be honored at our Annual Celebration and Awards Reception. We would appreciate if you could be present to share a few words about the awardee! You can RSVP here (link).