Service-Learning
Project Report Form Please complete this form and
print it. Then return a copy of the completed form to your student teaching supervisor or course instructor. In general,
your responses should not exceed the length of the provided text
boxes. Also note that some web browsers do not print text entered
into web page forms. In that case, you may also save this document
and word process your responses. Refer to the home
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printing and saving instructions.
Name:_
Present Address and Phone:
Name of Service-Learning Activity:
Grade Level:________Time
Required/Period of year:
School and District Where Activity Will Take Place:
Supervising K-12 Teacher:_
Brief Description of the Activity (With whom will you work in the
comunity? What resources will you access in the community?):
Academic Component of Activity (How does it fit the school's
curriculum or outcomes?):
Service Component of Activity (How does this activity benefit the
community?):
Reflective Component (How will students reflect on the S-L
activity?):
