Return form to Instructor by________

Service Learning & Community Outreach Student Placement Agreement
The Service Learning program at TCC is committed to enhancing our students’ education by integrating academic courses with community service, as stated in TCC’s general education goal “civic responsibility”. By connecting their classrooms with local issues and challenges, faculty give students the opportunity to apply their course learning, to reflect on serious social problems and solutions, and to see themselves as engaged community members.

To be completed by instructor: | Course: | BIOL1224 | | Instructor: | Mary Phillips | Service hours Assigned: | | | Instructor’s phone: | 918 595-7689 | Learning goals: | | |

To be completed by student: | | To be completed by community site supervisor: | | | | (Student name – printed) | | (Community site – printed) | | | | (Student address) | | (Site address) | | | | (Student phone) | | (Site phone) | | | | (Student email) | | (On-site supervisor – printed) |

To be signed by Student and Site SupervisorPlease read the agreement located on the other side before signing | | (Student signature) | | (Date) | | (On-site supervisor signature) |

For more information, contact: Carol Carr, Director Engaged Student Programming TCC Northeast Campus 3727 E. Apache, Room 2220 Tulsa, OK 74115 ccarr@tulsacc.edu (918) 595-7595

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OPTIONAL: Student Demographics: (Requested for federal reporting purposes, not yet required)
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1) Year in School: Fr ____ Soph ____ Other___________
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2) Race/Ethnicity: ____Asian/Pacific ____Black/non-Hispanic ____Hispanic
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____Native American/Alaskan ____White, non-Hispanic ____Other________________
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3) Sex: ____Male ____Female
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4) Age: ____17-19, ____20-22, ____23-25, ____26-29, ____30-34, ____35-39
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____40-44, ____45-49, ____50-54, ____55-59, ____60-69, ____70+

The student will: 1. Be responsible for the agreed service hours, and will call ahead if running late or unable to attend a scheduled service shift. 2. Dress appropriately for the assigned activity and site. 3. Follow all policies of the site, including health, safety precautions, and confidentiality policies. * Not go beyond the scope of assigned responsibilities, and will use judgment in refusing risky or inappropriate requests and situations. * Not work in a room alone with a child or other client, or transport a child or other client in his/her personal vehicle. * Not talk about a client by name except with the supervisor.4. Inform the site supervisor of the learning objectives for the service learning course in order to connect the service experience with the course.5. Notify the supervisor and/or the instructor of any concerns or changes. |

The community site will: 1. Provide position descriptions, outlining expectations. 2. Provide a structured orientation to the program and appropriate training for the position prior to the beginning of the service activity.2. Provide necessary space, equipment, and materials for the student to function effectively in the position. 3. Have clear risk management and personnel policies and procedures in place and include these in student training. 4. Provide a supervisor to guide and evaluate the student. Provide clear procedures for the student to report problems, get assistance, or make suggestions. 5. Relate the student’s service assignment to the course learning objectives, keep a record of student hours, and complete an evaluation form provided by Tulsa Community College. 6. Notify the student and/or the instructor of any concerns or changes. |

The TCC instructor will: 1. Approve the service learning opportunity and provide written learning objectives for the student to take to the site. 2. Orient students to the purposes of service learning, its relation to the course, and the importance of commitment and respect at the service site. 3. Stress the importance of students’ finding placements at the beginning of the semester. 4. Ensure a solid service learning experience by providing opportunities for students to reflect on their service and integrate it with the academic course. 5. Notify the student and/or the site supervisor of any concern or changes. |

TCC Recommendations: 1. TCC recommends that students carry health, accident, and auto insurance, as they are not covered under any college insurance policy. 2. TCC recommends that the community site have volunteer accident and liability coverage. |