Service-Learning Student-Initiated Project Proposal

Service-Learning

Student-Initiated Project Proposal

This proposal form is for students designing their own service-learning project. Students specify the community partner, activity, learning goals, and risk & liability.

INSTRUCTIONS:

Consult with your instructor to identify your learning outcomes and project parameters.
Identify a community partner and project that fits the learning outcomes of your course. For tips on how to initiate contact with an agency and negotiate a project with them, please see Ten Steps to Succeeding In Your Student-Initiated Service-Learning Project
Ask the organization if they carry liability insurance covering volunteers. This is required.
Please review “Risk & Safety” guidelines.
Complete this form before starting service. It will be routed for approval by your community partner and instructor.

If you have questions about this form, contact Service-Learning staff at servicelearning@boisestate.edu.

Please note these Sevice-Learning Program policies:

The service must be with a community organization whose primary purpose is providing a significant public service or public good (most likely this will be a nonprofit, government, or B-corps which addresses a community need).
Students are not allowed to count SL hours for activities that involve lobbying or require religious instruction and/or worship.

General Information

Student Name*

Boise State Student Email*

firstnamelastname@u.boisestate.edu

Student Phone*

Phone

What course is this project proposal for?*

Ex: ENVSTD 121, SOCWRK 201

Your instructor's name*

Your instructor's email*

Community Partner / Agency Name*

Community Partner Contact Person*

Community Partner Contact Person’s Email*

Community Partner Contact Person’s Phone Number*

Phone

Community Partner Address*

What is your anticipated start date, based on conversations you have had with your community partner?*

Please keep in mind that this form should be approved by your faculty and community partner prior to starting your service. This is an anticipated start date and can change based on circumstances.

What is your anticipated end date, based on conversations you have had with your community partner?*

Prior to your last day, talk with your community partner about how to transition out.

Is there any other information that your faculty or community partner needs to know?

Course Related Information & Questions

What are the learning objectives of the course?*

Ex: Apply communication skills to engage effectively with older adults

What are the learning goals for the service-learning in this course? Or, what do you and your instructor hope you get out of your experience?*

Ex: To gain experience working with clients experiencing homelessness.

What community issue will you address?*

Ex: domestic violence, homelessness

If hours are a requirement, how many service-learning hours will you complete?

What specific tasks will you complete?*

Ex: completing needs assessment, meeting with clients, creating newsletter.

The more specific you are here, the better!

How might this experience prepare you for a future career?*

How will the community agency/service recipient be involved in the planning and evaluation of this service?*

What special requirements/training are required by the community partner for this experience?*

Ex: driver’s license, background check

Safety & Risk Management Information and Agreements

Does this project deal with vulnerable populations? If you do deal with vulnerable populations, describe how you will protect the well-being and privacy of the population you are working with. (Consult with your community partner)*

Ex vulnerable populations: children, individuals with disabilities, elderly

Please describe any substantial risks of injury or property damage to persons associated with the activity (if applicable) and how you will reduce this risk and/or address issues of liability?*

Read the statement below and certify your understanding by selecting the drop down.*

Service-learning activities can involve risk. However, participants can work together to manage risk and promote safe, minimal-risk environments. For guidance read this list of safety tips.

Select

Read the statement below and certify by selecting the drop down.*

Assumption of Risk: I acknowledge that there are certain risks of injury and/or damage to property associated with the activity described above. I acknowledge that I have read the course/program outline and voluntarily accept all risks associated with the activities. I further agree that if I drive my own motor vehicle for transportation to, during or from the program site, I am responsible for my own acts and for the safety and security of my own vehicle. I accept full responsibility for the liability of myself and my passengers.

Select

Read the statement below and certify by selecting the drop down.*

Waiver of Personal Property Liability: I agree to hold Boise State University and all its officers, agents, and employees free from liability in the event I suffer personal property loss or damage as a result of participating in the field trip/event, due to my negligence

Select

Read the statement below and certify by selecting the drop down.*

In case of injury, students are covered under worker's compensation, subject to review from the insurance agency. If the student deviates from their scope of work, worker's compensation may deem them ineligible for coverage.

Select

Any additional notes or comments you would like to add regarding your Student-Initiated Service-Learning Project?

Please do not ask questions here.

Today's Date*

Send me a copy of my responses

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