The Center for Service Learning

 
 
 

Student Release Form

The Center For Service Learning
7201 Rossville Boulevard
Baltimore, Maryland 21237
Social Science and Human Development Building
L Building--Room 313A
Phone: 443-840-1409

E-mail: tgordon@ccbcmd.edu

  1. Be sure of the assigned site, location, phone number, supervisor, and the date and time of your service prior to the service date.

  2. Before you return the form indicating that you have completed your assignment make sure that it is complete and includes signatures of the site supervisor as well as your own.

  3. Be aware that you will not receive credit for your work unless you complete your service assignment.

  4. Please understand that you have entered into a cooperative obligation and that you agree to fulfill your responsibility to your assigned service site.

Statement of Confidentiality

I understand that all activities in which I am involved as a service learning participant are to be kept in the strictest of confidence.  I will not release or exchange any type of personal information concerning clients of the agency I am to serve without written authorization from the appropriate organization supervisors.

Signature: ________________________________________________

Date: ______________
   

Please note: Students should carefully read, sign, date, and return to the following address upon completion:

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