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Student Service Pre-approval Form

Contact Information:      
Student First Name:    
Student Last Name:    
Student Email Address:       
Student ID Number:
example: 999123456   
Instructor 1 Name:

Instructor 1 Course Name:

Instructor 1 Course Number:
example: Psy 6711 01 101S

Instructor 2 Name:

Instructor 2 Course Name:

Instructor 2 Course Number:
example: Psy 6711 01 101S

Instructor 3 Name:

Instructor 3 Course Name:

Instructor 3 Course Number:
example: Psy 6711 01 101S


Complete the following form and submit PRIOR to completing the service activity/project. All service activity/project ideas must be pre-approved by the Director of Service Learning to receive credit for social science courses. Service completed without pre-approval will be rejected and a zero posted in the course grade book. You may use hours for one activity/project toward more than one course this semester, however you will need to remember to submit a separate reflective assignment for each course (see Step 3 for more information).

Name of Organization to be served:   

Name of organization contact person:


Organization or Contact Phone number:


Organization or Contact E-mail:


Describe the service you expect to provide and how your service will be considered Service Learning rather than Volunteering:




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