ࡱ> KlJk XbjbjȬ 80΢,j΢,jX }}}}}4L********-x0P*}r"*}}a*000}}*0*00'|;)) 5:?(**0*Q(00$;);)0}O)00***0Y C:  Student/Agency Partnership Agreement: Due ______ To be completed by instructor before assignment is given Instructor Name: _________________________________________Course Name & Number: _______________________________ Instructor Phone: _______________________________ Instructor Email: _______________________________________________ Details of student assignment: Student should select a community-based organization, specifically _____________________________________ ______________________________________________ (specific criteria, if any, for selecting an organization) Students should complete ____ hours of direct service or a deliverable project (circle one or both) Description of expected activities:  Dear Agency Supervisor, Thank you for entering into an educational partnership with our students. When you accept and supervise service-learners, you are helping students connect classroom knowledge with real-life experience. Your time and contributions as a mentor and educator are greatly appreciated. Students Name:______________________________ Students Phone and Email _______________________________________ Students Emergency Contact Name and Phone Number: ___________________________________________________________ Name of Agency: __________________________________________________________________________________________ Agency Contacts Name, Phone and Email ______________________________________________________________________ Location/address of work: ___________________________________________________________________________________ Students and potential partners should meet to discuss and decide on the below information and sign the agreement, with both parties reserving a copy and forwarding a copy to ___________ (instructor email). Project goals and action steps (must have at least 3; specify responsibilities, projects or tasks): Responsibilities, projects, tasksAnticipated hours spentWhen during the semester will student work on this and what is the deadline for completion  Proposed date/time/place for student and community partner to have a midterm check-in: ____________________________ How will you define success for this project? 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