Community-Based Learning

Forms

The following forms are available for faculty, students, and site supervisors. Faculty, if you find these forms do not fit with your class assignment, please let us know and we will work with you to develop a different documentation method.

Most forms are integrated into your course in GivePulse. Before filling out any forms that are available as PDF files, download and save to your computer first. 

Learning Agreement

Instructors, contact the CBL Program Coordinator to set up a Learning Agreement for your course(s) in GivePulse.

Purpose
  • To clarify expectations and learning objectives.
  • To keep a record of students involved in Community-Based Learning.
  • To facilitate communications with community partners.
  • To promote safety and reduce risk.
CBL Learning Agreement Expectations
The Student Will:
  1. Identify themselves as a PCC student and review the course CBL assignment, learning objectives and personal learning objectives. This should be done during the initial contact with the Community Partner, so they understand student’s learning goals.
  2. Be responsible for the scheduling with the Community Partner and commit to completing the CBL assignment.
    • In case of an unexpected scheduling conflict or emergency, notify the Community Partner as soon as possible.
  3. Adhere to the PCC Student Code of Conduct while completing CBL assignments with community partners. Students are a representative of the college during their community engagement experience.
  4. In addition to following all policies of the site, including health and safety precautions and confidentiality, do the following:
    • Use good judgment regarding health and safety precautions and confidentiality.
    • Do not go beyond the scope of assigned responsibilities. Use your judgment, and refuse risky or inappropriate requests and situations.
    • Do not work in a room alone with a child or other client, or transport a child or other client, unless screened and cleared by both the Community Partner and Instructor to do so.
    • Maintain the confidentiality of the people you meet during your community engagement experience.
    • We recommend that students carry personal health and auto insurance.
  5. Contact the instructor for clarification, get assistance, and/or discuss concerns.
    • Immediately contact the instructor to report problems or inappropriate activities
The Community Partner Will:
  1. Review the learning objectives for the course assignment and personal learning objectives for the student.
  2. Provide student with clear expectations, requirements, and responsibilities.
    • If applicable, provide orientation to the agency and to the issues and populations it serves, and provide appropriate training for the student’s role.
  3. Provide a safe and appropriate working environment.
    • Determine what equipment and materials are needed for the student to engage effectively and who will provide those materials and equipment.
  4. Provide verification of the student’s community engagement experience.
    • Keep a record of student hours, if required.
    • Complete an evaluation of the student if provided by PCC Instructor or CBL Program.
  5. Notify the student of any concerns or changes.
  6. Contact the instructor for clarification, get assistance, and/or make suggestions.
    • Immediately contact the instructor to report problems or inappropriate activities.
The Instructor Will:
  1. Provide written learning objectives for the students to take to the Community Partner.
  2. Approve the Community Partner and community engagement experience. If you have questions about specific partnerships and/or activities, consult with the CBL Program.
  3. Orient students to the purposes of CBL, the connection of community engagement with the course, and the importance of reciprocity and mutually beneficial community partnerships.
  4. Ensure a solid community-based learning experience by:
    • Providing opportunities for students to reflect on their community engagement and integrate it with the course.
    • Ensuring that the CBL time commitment expected is aligned with the overall student engagement hours for course based on credits.
  5. Notify the students and/or the Community Partner of any concerns or changes.
  6. Address any problems or inappropriate activities.
    • Contact the CBL Program for support and assistance as needed.
Procedure for courses where students can select the community partner
  1. Instructor provides information for CBL Learning Agreement (suggestion for where students can find this info: assignment/project description, syllabus, or course’s GivePulse group)
  2. After making arrangements and reviewing the CBL Learning Agreement with their Community Partner, student completes CBL Learning Agreement using the CRN specific link for the course
  3. Instructor & CBL Program are notified of submission
  4. Instructor completes the initial review
  5. Community Partner completes secondary review
  6. CBL notifies student that they are able to start community engagement activities
Procedure for courses where instructor has selected the community partner(s)

Instructors, if you have made arrangements with a specific community partner for your course, utilize this CBL Learning Agreement for Course Partnership. This will allow the Community Partner to sign off on a single Learning Agreement that applies to all the students who engage with them for your course’s CBL project/assignment.

  1. Instructors are responsible for communicating the CBL Learning Agreement Expectations with students and the community partner
  2. Instructors must submit to the CBL Program with either hard signatures, electronic signatures, or email acknowledgement by the community partner
  3. Student will complete the CBL Learning Agreement using the CRN specific link for the course
  4. Instructor & CBL Program are notified of submission
  5. Instructor completes the review
  6. CBL notifies student that they are able to start community engagement activities

Photo release

Photo Release Form

Purpose
  • This form is needed whenever PCC uses photographs of students or community members. It is a signed statement from the individuals in the picture that they allow the college to use their picture.
Procedure
  1. Prior to taking pictures, ask those present for permission.
  2. Once you have taken pictures, ask those who appear in the picture to sign a photo release.
  3. On the release (front or back) make some notes to identify the person in the picture (clothing, hair color, glasses, seated, standing, etc.)
  4. Please either email the pictures to your instructor or to the Community-Based Learning Coordinator.
  5. Please send originals of the form to the Community-Based Learning office.

Liability Waivers

Instructors, contact the CBL Program Coordinator to set up Liability Waivers for your course(s) in GivePulse.

Purpose
  • This form is needed whenever PCC students participate in an activity outside of the classroom. It is a signed statement from the individuals that they accept responsibility for risks associated with the activity.
Procedure for Instructors
  • Prior to the activity or travel, ask students to complete liability waivers through your course in GivePulse.

Supervisor Evaluation

Individual Student Evaluation
Student Group Evaluation

Purpose
  • To account for students’ successful completion of community-based assignments.
  • To provide faculty and students with feedback on their community involvement.
Procedure for Instructors
  1. Complete the PCC Instructor section, including the due date (so that you will receive the form back before the end of the quarter).
  2. Copy the form (or one of your own) for students to take to their supervisors.
  3. Supervisors complete the evaluation form at the end of the quarter.
  4. Please send originals or copies to the Community-Based Learning office.

Student Evaluation

Student Project Site Evaluation

Purpose
  • To assess students’ Community-Based Learning experience.
  • To develop a database of recommended Community-Based Learning sites.
Procedure
  1. Students complete the evaluation forms in class at the end of the quarter.
  2. Please send originals or copies to the Community-Based Learning office.

Faculty Recognition

Faculty Nomination (Online Form)

Purpose
  • Every year the CBL Program recognizes faculty who have demonstrated a deep commitment to community-based learning through their dedication to CBL best practices, commitment to community responsibility, and/or commitment to high academic rigor.
Procedure
  1. Submit nomination form.
  2. Awardees will be honored at our Annual Celebration and Awards Reception. We would appreciate if you could be present to share a few words about the awardee! You can RSVP here (link).