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: 410-780-6409
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Be sure of the assigned site, location, phone number, supervisor,
and the date and time of your service prior to the service date.
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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.
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Be aware that you will not receive credit for your work unless you
complete your service assignment.
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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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