Faculty CSL Course Assistance Request Form

Community Service Learning @ Western is dedicated to supporting you in including Community Service Learning in your course curriculum. The following questions will allow you to consider all aspects of your CSL course and will provide CSL @ Western all the information they will require to work with community partners on your behalf.

The information contained in this form will be what CSL @ Western uses to engage the community, so please keep this in mind when formulating answers.

Basic Course Information:

Name of Faculty Member:
Faculty Member Contact Email:
Faculty:	Please Select: Arts and Humanities Don Wright Faculty of Music Engineering School of Graduate and Postdoctoral Studies Health Sciences Information and Media Studies Law Richard Ivey School of Business Schulich School of Medicine & Dentistry Science Social Science Brescia University College Huron University College King's University College
Department, School or Unit:
Course Code and Course Title:
Term:	Please Select: Fall Winter Full Year Intersession
Estimated Number of Students:

Community Service Learning Outline:

Please indicate the format you would like the CSL portion of your course to take.

For this course, the CSL component will be:	Mandatory Optional

Placement Based

My hope is that individual students will each dedicate hours per week for a total of weeks with a community partner organization for a combined total of hours.

In total, this course will seek to place students with community partner organizations.

or

Project Based

My hope is a group of students will each dedicate hours per week for a total of weeks with a community partner organization for combined total of hours per student or for the whole group.

In total, this course will seek to place groups of students in community projects.

The CSL experiences will begin (MM/DD/YYYY):
The CSL experiences will end (MM/DD/YYYY):

Course Details and Learning Objectives:

The following is a brief description of my course: (max 250 words)
Engaging in a Community Service Learning experience will allow students to meet the following learning objectives: (minimum of 3)	1. 2. 3. 4.
What I would like students to DO (i.e. activities) with community partner organizations include:
What I would like students to KNOW as a result of working with community partner organizations includes:
What I would like students to UNDERSTAND through engaging with community partner organizations includes:
If the community partner can expect that a specific deliverable will come from this partnership, please indicate this here if applicable. In other words, what will the organizations receive as a result of the students' work? Past examples include but are not limited to an executive summary of recommendations, a video or film, a specific resource, literature review, or report)

Community Partner Engagement:

As a faculty member, I would like to be involved in the following processes as partnerships for my course are developed (check all that apply):
	I would like to contact partners myself and then refer the partners to CSL @ Western to formalize the partnership
	I would like CSL @ Western to contact all partners on my behalf
	I would like to meet with each partner face to face. I can do this without the support of CSL @ Western
	I would like to meet each partner face to face, but I would like CSL @ Western to be there (please note that this will be dependent on the CSL Coordinator's availability)
	I will not be available to meet each partner face to face, but I would like to schedule telephone calls with each of them
	I would like to vet each proposed project/placement before the partner is officially confirmed
	I would like CSL @ Western to handle all aspects of finding partners and projects for my course
	Other (please describe)

Once all community partners have been finalized, they will be asked to engage with this course in the following ways:
	Attend an on-campus meeting between myself, CSL @ Western and the other community partners prior to the commencement of the course I would like to suggest the following dates and times for this meeting:
	Prepare and deliver a brief presentation to the class about the work of the community partner organization
	Be involved in the matching process between students and community partners
	Attend student class presentations at the end of the course
	Provide an evaluation of the student work with your organization
I plan on having the community partner evaluate the student in the following ways (if applicable):

Matching Students to Opportunities:

CSL @ Western usually asks the faculty member to administer the processes through which students are matched to opportunities. Please briefly describe the ways that you envision this process.

Reflection:

Reflection is a very important part of CSL, therefore we are interested in understanding your plans for reflection activities/assignments that will complement the CSL experience:
	My plans for including reflection in CSL include: (check all that apply)
		reflective journals
		class presentations
		blogs
		reflective essays/papers
		Other (please specify)
	I would like to work with CSL @ Western closer in designing these reflection activities/assignments
	I would like CSL @ Western to come into my class to conduct reflective discussions about students' experiences:
		Before - Proposed Date (MM/DD/YYYY):
		During - Proposed Date (MM/DD/YYYY):
		After - Proposed Date (MM/DD/YYYY):

Other Requests for Support from CSL @ Western:

I would like CSL @ Western to deliver the "Introduction to Community Service Learning" presentation to my class on the following date (MM/DD/YYYY): time: AM PM in the following location:

Is there anything else you would like CSL @ Western to know about your course or requirements for support?

To verify that you are a human, Please Enter the Text Below:

 

1151 Richmond Street, Suite 2, London, Ontario, Canada, N6A 5B8 • Tel: 519-661-2111
Updated by the Registrarial Webteam • See our policies on Privacy, and Web Standards