Affiliation Agreement

Instructor *

Email *

Course *

Start Date *

Month

Day

Year

End Date *

Month

Day

Year

Community Partner *

Name of students

(if known)

Clear expectations about the responsibilities of all parties are essential to a successful supervision relationship, and are outlined below.

Select one of the following *

Number of hours *

Number of weeks *

Total hours for the term *

Minimum hours *

Maximum hours *

Allow access to Organization / Company records as appropriate to assigned tasks.
Assist the student in the development of the project.
Provide a general exposure to the professional environment with opportunities for learning.
Communicate any problems to the course instructor.

Brief description of the anticipated service learning activities and/or final deliverable: *

Describe the service learning activity and its relation to the course objectives in the course syllabus.
Provide learning activities and discussion that help connect service learning with academic learning.
Connect with the student and / or project leader, periodically throughout the term, to establish student activities; discuss possible goals; and to strategize final items.
Identify problems as early as possible, and when necessary, devise a plan for their resolution.
Monitor the learning experience to ensure the learning objectives are being met.
Be available during the term, as well as at term end, to ensure project leaders are satisfied with student performance.

Uphold a level of professionalism in attire, language, and attitude, including keeping cell phone off.
Abide by organizational policies and procedures, including confidentiality and respect for privacy of clients.
Ask questions whenever unsure of any and all policies, procedures, project guidelines and expectations.
Maintain attendance and punctuality, and take the responsibility to reschedule any missed dates.
Promptly notify contacts about possibly missing a meeting, being late, or being absent (i.e. illness).
Discuss with the Project Leader, or Faculty member, any areas of disagreement, dissatisfaction, or confusion with respect to any part of the service learning experience.
Provide a letter of thanks to the Project Leader / Organization / Company for their help in assisting with learning outcomes.

Student and instructor will....

maintain strict confidentiality of any information, both written and unwritten;
use Organization/Company information for course work in designated course only; and
not disseminate, publish, present, or copyright any information without prior express written permission.

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