The Center for Service Learning

 
 
 


SITE SUPERVISION FORM

The Center For Service Learning
The Community College of Baltimore County, Essex campus
7201 Rossville Boulevard
Baltimore, Maryland 21237
BESS - 313A
Phone: 443-840-1409

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: ______

Date of Service

Hours Served at Site 

Supervisor’s Initials

Evaluation/Comments

       
       
       
       
       

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: 443-840-1409, School of Wellness, Education, Behavorial and Social Sciences :BESS 313A.  Thank you for your cooperation, Center for Service Learning.

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