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Service Learning Designation Form

This form is also used to submit the Armen Awards Proposal.

Click [here] for a complete list of the questions you are asked to address.

example: 1234
Semester course will be taught
Mode of Teaching
List (1) course learning outcome from the Course Document. Describe how the selected course learning outcome(s) will be met through the service learning experience. How will the experience allow/ensure the student will learn the knowledge, skills or attitudes described in the course learning outcomes? How will you assess this?
Select (1) of the outcomes listed below and describe how the outcome will be achieved and assessed. 1) Awareness of issues impacting the community, 2) Awareness of services and resources available in the community, 3) Understanding of how to participate in the community, 4) Establish a positive attitude towards serving the community, 5) Ability to draw connections from the service project to course concepts.
Choose (1) institutional learning outcome. Describe how the institutional learning outcome will be met through the service learning experience. How will the experience allow/ensure the student will learn the knowledge, skills or attitudes described in the institutional learning outcome(s)? How will you assess this? Outcomes include: Critical Thinking, Communication, Personal Responsibility and Social Responsibility.
Please list the community organizations your students will be serving and {provide email addresses}. If your community partners change regularly, please provide a general description as to who your partners usually are and detailed information about how you choose the partners each semester and identify the community need.
Please provide a brief description of what the students will be doing in the community. How was the service project determined? How did the community partner help shape the service project? How will you prepare students for a successful service experience?
Reflection helps students draw connections between the experience, course content and their lives. It also challenges students to use critical thinking skills and explore their role as citizens in the community. Describe your reflection activity and its connection to the course learning outcomes.
Please list 1-50 hours. We recommend (5) hours of service per credit hour.
Service Learning Requirement
Please attach a course syllabus, which should include the following a) Statement clearly identifying that the class has a service learning component and a link to the service learning resources for students web page (, b) an explanation of the service learning experience and how it will meet course objectives, c) expectations of how students will make contact and interact appropriately with community partners, d) a description of the reflection activity that will connect the service experience and course outcomes, and e) estimated number of hours that students will serve in the community
One file only.
2 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf, doc, docx.
Service Options
I agree that the course options ensure that no student is required to participate in a service placement that creates a religious, political or moral conflict for the student.
Department/Program Notification
You must make your department head or program director aware of this submission for service-learning designation.
I will ask my students and community partners(s) how I can improve this experience and to integrate feedback into future service learning practices.
Student Support
Students are to have essential abilities (skills, physical functions, communication, emotional coping and behavioral attributes) to be successful in service learning experiences. I will provide opportunities for students who have made me aware of a disability who feel they can achieve the course objectives with reasonable accommodations - and I will direct the student to Disability Support Services for additional support.
Armen Awards
I would like this submission to also be considered my proposal for the Armen Awards. The Armen Awards is a team competition event designed to inspire best practices for teaching and learning. Using the principles of innovation and service learning, students, faculty, and community partners form teams to create a product that results in shared impact.
We are able to financially support service learning courses upon request. If you needed additional funds, what would you use them for?