Skip navigation
(wgPageURL)
> Resources > Sample Forms and Templates
  Sample Forms and Templates
 
All the links below will open a new browser window. To return to this page, simply close the new window.
Search Sample Forms and Templates for the following words:


Categories:
Agreements/Contracts
Applications
Certificates/Awards
Evaluation and Assessment
Financial Forms
Job/Position Descriptions
Lesson Planning Templates
Miscellaneous Forms/Documents
Mission Statements
Policies/Guidelines
Promotional Materials
Public Relations Communications
Site Visit Documents
Spanish Language Documents
Surveys
Time Sheets
Workplans

Agreements/Contracts

Employee Service Project Placement Form
  The Employee Service Project (ESP) at Brevard Community College allows full-time employees to perform community service during regular work hours. This form is for recording details of the employee placement with an organization. Contributed by: Brevard Community College.
Fourth Credit Service-Learning Contract
  One-page contract agreement for using service-learning as a fourth (extra) credit. Contributed by: Brevard Community College.
Letter of Understanding
  One-page example of a letter of understanding between a community partner/agency and a community college service-learning program. Contributed by: Center for Learning Through Service, Anne Arundel Community College, a program funded by Learn and Serve America.
Parental Release Form and Child Background Sheet
  This document includes a letter to parent/guardians, a parental release form, and a sheet to fill out background information on the child participating in service-learning. Contributed by: Tennessee Academic Civic Engagement Program (TACEP), a program funded by Learn and Serve America.
Placement Confirmation Mutual Agreement
  One-page form confirming placement expectations of both the community partner and the service-learning participant. Contributed by: Brevard Community College.
Student Service-Learning Contract
  Three-page student service-learning contract and letter of agreement. Contributed by: Center for Learning Through Service, Anne Arundel Community College, a program funded by Learn and Serve America.
Volunteer Liability Insurance Enrollment
  Brevard Community College maintains personal liability insurance for volunteers, valid while participants are performing volunteer duties. This form enrolls the volunteer and also lists automobile insurance information for volunteers intending to use a personal vehicle during participation. Contributed by: Brevard Community College.
(back to top)
Applications

Center for Service-Learning Student Application
  Form for students to fill out giving contact information, volunteering history, and placement preferences. Contributed by: Brevard Community College.
Community Service Scholarship Application
  Sample application for student applying to receive on-campus award of community-service scholarship. Contributed by: Brevard Community College.
Employee Service Project Application Form
  The Employee Service Project (ESP) at Brevard Community College allows full-time employees to perform community service during regular work hours. This form is for interested employees to fill out, listing interests and availability. Contributed by: Brevard Community College.
High School Mentor Application
  Two-page mentor application for high school students, including a scheduling form for availability. Contributed by: Tennessee Academic Civic Engagement Program (TACEP), a program funded by Learn and Serve America.
Mentee Interest Application Form
  Application form for interest as a mentee in high school mentoring program. Includes a template for scheduling availability. Contributed by: Tennessee Academic Civic Engagement Program (TACEP), a program funded by Learn and Serve America.
Outstanding Student Humanitarian Scholarship Application
  Sample application for student applying to receive tuition award for outstanding community service contribution. Contributed by: Brevard Community College.
Service-Learning Leadership Scholarship Application
  Sample application for student applying to receive tuition award for service-learning leadership. Contributed by: Brevard Community College.
(back to top)
Certificates/Awards

Certificate of Appreciation
  Certificate of Appreciation in recognition of a campus-community partnership. Contributed by: Tennessee Academic Civic Engagement Program (TACEP), a program funded by Learn and Serve America.
Employee Service Project Appreciation Letter
  The Employee Service Project (ESP) at Brevard Community College allows full-time employees to perform community service during regular work hours. This is a sample letter of appreciation from the Center for Service-Learning to staff participants. Contributed by: Brevard Community College.
Multiple Sample Awards
  This 13-page document shows sample text and design for various awards. Included are campus-specific awards, student awards, and staff awards. Criteria for receipt of some of the awards are included. Contributed by: Brevard Community College.
(back to top)
Evaluation and Assessment

Campus Partner Needs Assessment Tool
  Three-page community partner needs assessment survey/tool. Contributed by: Keren Zuniga McDowell, Student Coalition for Action in Literacy Education (SCALE) at UNC-Chapel Hill, a program funded by Learn and Serve America.
Community Partner Questionnaire
  This two-page survey lets community partners evaluate their experience with student workers and with the service-learning office. Contributed by: Brevard Community College.
Employee Service Project Survey
  The Employee Service Project (ESP) at Brevard Community College allows full-time employees to perform community service during regular work hours. This one-page survey lets employees indicate if they currently perform volunteer work elsewhere and lets them indicate interest in participating in the school's program. Contributed by: Brevard Community College.
Evaluation Form and Service-Learning Hours Log
  Service-Learning hours log and evaluation form to be completed by site supervisor. Contributed by: Center for Learning Through Service, Anne Arundel Community College, a program funded by Learn and Serve America.
Faculty Community Service-Learning Evaluation
  One-page survey for faculty to rate the effectiveness of the service-learning experience in their classes. Contributed by Brevard Community College; form created by University of Minnesota.
Faculty Follow-up Evaluation
  Follow-up evaluation for community college faculty members involved with service-learning. Contributed by: Tennessee Academic Civic Engagement Program (TACEP), a program funded by Learn and Serve America.
Faculty Questionnaire
  One-page form for faculty to give feedback on their service-learning experience by rating various aspects on a scale from poor to excellent. Contributed by: Brevard Community College.
Faculty Service-Learning Component Assessment
  One-page feedback form for faculty to fill out. Evaluates the addition of the service-learning component to course instruction. Contributed by: Brevard Community College.
Faculty Training Evaluation Form
  Two-page sample evaluation form for faculty members who attended the Columbia State Community College Service Learning Curriculum Integration Training. Contributed by: Tennessee Academic Civic Engagement Program (TACEP), a program funded by Learn and Serve America.
Institutionalization Checklist
  This tool contains a series of questions about the state of your community-based research taking place on campus in individual programs, but also within the context of the entire university. Contributed by: The National Community-Based Research Networking Initiative, a program funded by Learn and Serve America.
Integrating Service and Academic Study Oral Survey
  This one-page preliminary survey is to ascertain a faculty member's familiarity with and interest in service-learning as a course component. Contributed by: Brevard Community College.
Learning Objective Assessment/Accomplishments Log
  This simple grid is for recording learning objectives, evidence of achievement, date of completion, and what is left to accomplish. Contributed by: Brevard Community College.
Maryland Best Practices Rubric
  Rubric for assessing the use of Maryland’s Seven Best Practices of Service-Learning. Contributed by: Maryland Student Service Alliance/Maryland State Department of Education, a program funded by Learn and Serve America.
Maryland LEA Leadership Rubric
  Rubric for assessing the quality of LEA service-learning leadership. Contributed by: Maryland Student Service Alliance/Maryland State Department of Education, a program funded by Learn and Serve America.
Maryland School Leadership Rubric
  Rubric for assessing the quality of school service-learning leadership. Contributed by: Maryland Student Service Alliance/Maryland State Department of Education, a program funded by Learn and Serve America.
Maryland Service-Learning Evaluation Tool
  Four-page evaluation tool for K-12 service-learning programs. Contributed by: Maryland Student Service Alliance/Maryland State Department of Education, a program funded by Learn and Serve America.
Mentor Assessment of Mentees
  Two-page assessment form for mentors working with youth. Contributed by: Tennessee Academic Civic Engagement Program (TACEP), a program funded by Learn and Serve America.
Post-Conference Evaluation
  One-page sample post-conference evaluation form for community college faculty/administration. Contributed by: Tennessee Academic Civic Engagement Program (TACEP), a program funded by Learn and Serve America.
Rubric for Levels of Reflection
  This rubric can be used for assessing the level of reflection in student assignments. Contributed by: Jean Strait, Hamline University
Service-Learning Option Assessment Feedback
  Form for instructors to provide feedback on how the service-learning component affected their course. Contributed by: Brevard Community College.
Service-Learning Start-Up Faculty Survey
  Survey for faculty to indicate involvement with and interest in community service activities connected with course requirements. Faculty can state what impediments might exist to including service-learning in their course(s). Contributed by: Brevard Community College.
Student Final Report
  Two-page form for student to write short responses about the service-learning experience. Questions deal with emotional aspects (happiest/angriest/saddest moments), achievements and failures, and let students list what they have learned. Students can write about concerns and suggestions as well. Contributed by: Brevard Community College.
Student First Impressions
  Records student impressions of service-learning center: helpfulness and friendliness of staff, efficiency of application process, etc. Contributed by: Brevard Community College.
Student Mid-Semester Progress Report
  One-page evaluation tool to rate students' progress in various areas related to performing service-learning. Contributed by: Brevard Community College.
Student Questionnaire/Survey
  Two-page detailed survey for students to fill out about how participation in the service-learning experience has affected them personally and academically. Contributed by: Brevard Community College.
Student Self-Assessment
  This document consists of a short survey and rubric for student self-assessment of service-learning projects. Contributed by: Jean Strait, Hamline University
Student Service-Learning Questionnaire
  Two-page form for students to evaluate service-learning program and how it has affected them personally and academically. Contributed by: Brevard Community College.
Student Summary of Self-Assessment for Service-Learning
  Single page asking students to give details about their skills, interests, and requirements/constraints related to performing service-learning. Contributed by: Brevard Community College.
(back to top)
Financial Forms

Final Fiscal Report
  Two-page end-of-year fiscal report from program coordinator to Learn and Serve America. Contributed by: Louisiana Serve Commission, a program funded by Learn and Serve America.
Interim Fiscal Report
  Mid-year fiscal report from program coordinator to Learn and Serve America. Contributed by: Louisiana Serve Commission, a program funded by Learn and Serve America.
Mid Year Financial Report
  Spreadsheet template used for mid-year financial reporting of service-learning grant funds. Contributed by: Maine Department of Education, a program funded by Learn and Serve America.
Monthly Payment Invoice
  Monthly payment invoice from program coordinator to Learn and Serve America. Contributed by: Louisiana Serve Commission, a program funded by Learn and Serve America.
Year End Progress Report Template
  2-page template for service-learning program year-end progress reporting. Contributed by: Maine Department of Education, a program funded by Learn and Serve America.
(back to top)
Job/Position Descriptions

Administrative Support Assistant II
  Administrative Support Assistant, working for the director of service-learning center. Contributed by: Brevard Community College.
Community Partner Job Description
  Form for recording requirements of student position(s) offered by community partner. Also lists community partner contact information. Contributed by: Brevard Community College.
Director
  Directs and provides overall administrative support for service-learning program. Creates, enhances, and directs service-learning initiatives for students, faculty, staff, and community organizations. Reports to executive vice-president. Contributed by: Brevard Community College.
Organizational Chart
  Sample organizational chart showing service-learning positions within structure of campus administration. Contributed by: Brevard Community College.
Project Coordinator
  The Project Coordinator coordinates activities of the center for service-learning, is responsible for several key projects, and provides administrative support to the director. Contributed by Brevard Community College.
Student Worker
  Provides clerical and administrative support to the service-learning center. Contributed by: Brevard Community College.
Task List for Student Worker