Service Learning Internship Contract

Service Learning Volunteer Center
Linda Anderson
Northwestern Michigan College
Room LB-200C
(231) 995-1294
landerso@nmc.edu

Please type your responses, print the page, and deliver it to the Social Science office. Please do not type beyond the bottom of the visible area of the boxes as it will not print. Add additional pages as necessary. Use the <Tab> key to move from one field to the next as you complete the form.

Semester: Year:

Student:
SSN: Telephone:
Address:
City: State: Zip:

Catalog Number & Title: Academic Service Learning Credit
Instructor: Telephone:
Supervisor: Telephone:

Organization:
Address:
City: State: Zip:

Hours/Week: Beginning Date: Completion Date:

1. What is the nature of your placement, and what will your specific responsibilities be?

2. What type of supervision will you have? How often? In-service training? When and how will you be evaluated by the organization?

3. What are your particular learning objectives for this placement and in what way will this experience allow you to accomplish these objectives?

4. What are your arrangements for meeting with your faculty sponsor and/or service learning coordinator?

Student Signature:

Supervisor Signature:

Instructor Signature:

Service Learning Coordinator Signature: