STUDENT/COMMUNITY PARTNER CONTRACT

STUDENT NAME: ____________________________SS#_____________________

PHONE NUMBER______________________

Students fill in information on form after consultation with community partner

LEARNING GOALS:

____________________________________________________________________

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

WHAT ISSUE(S), COMMUNITY CHALLENGE(S) WILL STUDENTS

ADDRESS? (Ex: care and services for senior citizens, community mental health, tutoring or mentoring children or adults, improving environment)

WHAT STRATEGIES WILL YOU USE TO LEARN MORE ABOUT THESE ISSUES?

(ex: direct involvement with clients/programs; involvement with personnel responsible for organizing and coordinating programs, attending meetings and planning sessions)

Organization/Agency: Name____________________________________________

Address ____________________________________________

Contact Person, supervisor_____________________________________

Title_____________________________________

Phone number_____________________________________

Signature of student _____________________________________________

Signature of supervisor____________________________________________

Signature of professor _____________________________________________