Form I: Community Engagement Learning Agreement

Student will complete a minimum of 16 hours of work engaging with a community agency whose primary mission is to improve the social conditions in and around the immediate community. Upon submission of this form, the SYMP Director will circulate copies of the form to the student, the On-site Reflectors Convener, and the student's mentor.

The 16 hours of community engagement work may be completed as two full-time, 8-hour days over the course of the Spring semester, OR as 2 hours per week over any 8-week period during the Spring semester. Students should arrange with their ministry context to be relieved of their primary duties for this sixteen hours of work in the community engagement setting.

Students should complete this form, which will be forwarded by the SYMP Director to the student, the students' mentor, the On-site Reflectors Convener, and to the community agency.

Name of Student *

Student email *

Semester (e.g. Spring 2022, Spring 2023) *

Provide the name of the community agency with which you intend to work *

Agency address *

Name of your primary contact at the community agency *

Agency phone number

Agency web site

Agency primary contact email *

What is the mission of the community agency with which you intend to work? (You can usually find the agency's mission statement on their web site. If you can't find the mission statement on the internet, ask your agency contact for the organization's mission statement.) *

Name of Mentor

Mentor email *

OSR Convener *

Convener email *

This form submitted by (type your name here) *

Today's Date: * +

Student Signature *

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