Service-Learning Assignment
Service Site Placement

Dear Agency Supervisor,

On behalf of the Oakton Community College Service-Learning Program we would like to thank you for entering into an educational partnership with our students.  By accepting and supervising service-learners, you are helping these students join classroom knowledge with real-life experience.  By encouraging and allowing these students to perform meaningful service, you are also contributing to education's mission of promoting civic responsibility.  The critical role you play as a mentor and educator for our students cannot be underestimated.  We appreciate your commitment to making our students feel welcome and to ensuring that them have a productive and educational experience.

Student;s name:______________________________  Social Security ________________

Course Prefix: Number:Section:______________  Course Name: ____________________

Faculty Member's Name: _________________________________________________________________

Name of Agency: _______________________________________________________________________

Address of Agency: __________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Name of Supervisor/contact person: 
_________________________________________________________

Telephone number: ______________________________________________________________________

Description of service activities: ________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

I agree to, and will uphold, the terms of this placement.

Student's Signature:  _____________________________________Date:  ______________

Supervisor's Signature:  __________________________________Date:  ______________