service-learning course information form.

If you have a course with several projects with the same community partner, you may simply use the same form and describe all of the projects briefly in the project description block.

If you have more than four community partners, please use a new form for each community partner/project. On subsequent forms, please just include your last name and the course number.

Note: An * indicates a required field.

Your Contact Information

First Name:
*Last Name:
Title:
Department:
Office Number:
Phone:
Email:

Course Details

*Course Number:	Example: PHIL 1010
*Course Section:	Example: 001
Course Name:
Semester:
Year:
Number of Students
Est. Hours of Service-Learning per Student

Community Partner / Project Information

Project 1
Community Partner:
Contact for Community Partner
Contact's Phone:
Project 1's Description:
Project 2
Community Partner:
Contact for Community Partner
Contact's Phone:
Project 2's Description:
Project 3
Community Partner:
Contact for Community Partner
Contact's Phone:
Project 3's Description:
Project 4
Community Partner:
Contact for Community Partner
Contact's Phone:
Project 4's Description:
Note: Only select the Override Blank Fields button when you intentionally leave some nonessential fields empty. If you click Submit when these fields are empty, then you will be directed to a page explaining what fields are empty. Then you will be redirected back to this page to either fill in the empty fields or click the Override Blank fields button. This is to prevent unintentional, premature submissions that are likely to occur when you press Enter on your keyboard.

If you are having problems with this form or have suggestions or general comments, please contact Carlynn at chartmankurtz@mail.unomaha.eduor 554-2712. If you cannot reach her, please call 554-2427.