SITE SUPERVISION FORM
The Center For Service Learning
The Community College of Baltimore County, Essex campus
7201 Rossville Boulevard
Baltimore, Maryland 21237
L Building -- Room 313A
Phone: 410-780-6409
E-mail: tgordon@ccbcmd.edu
Student Name: ____________________________________
Instructor Name: ____________________________________
Agency/Site: ___________________________________________________
Site Supervisor (Signature Required): _____________________________________
Date on which service learning activities begin ______ Date on which service learning activities end _____
Required number of hours to complete: ______
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Date of Service
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Hours Served at Site
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Supervisor’s Initials
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Evaluation/Comments
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TOTAL NUMBER OF HOURS SERVED/COMPLETED: ______
Please Note: Students should return this form and any other additional required Service Learning information to their instructor and/or academic adviser for formal evaluation upon its completion. In the event of problems and/or questions, contact the Center for Service Learning at CCBC Essex Campus Phone#: (410) 780-6409, Division of Business, Social Sciences, Health and Wellness, Office: Room L313A. Thank you for your cooperation, Center for Service Learning.
Back to Service Learning
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