Community Service Log

12A.
College of Southern Nevada Education Department’s

Service Learning Assignment (10 Hours)
EDU 280 - Valuing Cultural Diversity
Imagine the difference in the Las Vegas community, when you become a part of
it!
Teachers make our community requirement within your EDU 201, 202, or
better... outside the classroom 203 course.
too.
How it works... On the next page, you will
Whether seeking employment with a local read about approved ways to satisfy the Service
Learning component of your EDU 280 class.
education agency, applying for an education These suggestions can be used alone, or in
scholarship, or writing a proposal for grant combination, to arrive at the minimum 10 hour
funding, it is important that an applicant Service Learning requirement. This assignment
show a genuine commitment to their is worth 10% of the total grade of our EDU 280
community. course
The Service Learning component of your Use the Service Learning Pre-approval form
CSN EDU 280 class gives you the (page 3) and submit to your EDU 280 instructor
opportunity to build upon your existing to get pre-approval for your project before you
begin. Use the Service Learning Log (page 4)
community service commitment, or set the to document your hours of service, along with
foundation for many years of community any supporting material required by your
involvement and service to others. As a instructor. A letter on agency letterhead from an
matter of fact, statistics show that most organization administrator is the typical
teachers began thinking about education as documentation needed to validate your hours.
a career after volunteering in some capacity Your instructor will provide you with more
with local schools, religious groups, or information about how they will want these
community organizations. documents submitted, and their specific due
dates during the semester.
Your Service Learning is not the same as This documentation should also be archived for
your 10 hour CSN Field Observation use in your EDU 299 course.
1
Service Learning Component (10 Hours)
Approved Service Learning Choices

Community Service Organized Field Trip for this EDU 280 course.
Option in which the Your CSN instructor may
student works in a be able to organize an Other Service The
volunteer capacity at any educationally based field student can design and
non-profit agency that trip in which all members present a unique service
allows volunteers, and that of the class meet at oriented educational
serves the betterment of another location, instead experience to their
school age children in the of attending class at the instructor. The proposal
community. This agency is regular scheduled time to must be in writing and
one in which the student earn service credit. agreed upon by the CSN
solicits and can obtain a Students must fill out student and CSN
verified letterhead of CSN’s Field Trip Waiver instructor prior to
participation or certificate and provide it to the accumulation of hours.
from the organization’s instructor before traveling
leadership that documents to a sponsored off-campus YOU MAY NOT list any
their participation and event. Credit hours and CCSD public school as the
hours of credit once verification for this agency for this Service
completed. experience will be Learning Proposal. Why?
determined by your First of all, the 10 hours of
Private School (non-CCSD) instructor. Field Observation you
The student must arrange completed during your
contact and obtain written “CSN Serves” Volunteer EDU 201, 202, or 203
permission from the If you have no idea where courses is independent of
private school’s to start, consider visiting the 10 hours serving the
administration prior to the CSN Serves website community at a non-profit
visitation, and must have and signing up there agency. DO NOT cold call
an officer of the school https://www.csn.edu/csn any CCSD school to ask
provide signed verification -serves CSN Serves permission to volunteer
upon school letterhead of already has a number of there. No CCSD schools
the type of service agencies that you can will be pre-approved for
performed, and duration of volunteer at, and also earn this EDU 280 course.
the community service to transcript credit along with
the private school. meeting the requirements
2
Service Learning Pre-approval (10 Hours)

Complete this form and submit to your CSN instructor before proceeding with your contact hours
Your Full Name: Nick Bones
CSN Professor: Robert Shkorupa
Agency Name: New Vista
Agency Address: 5220 W. Charleston Blvd.
Agency Phone: 702-443-4325
Agency Contact Person: Destiny Bones
Contact Person’s email: DestinyxxBones@gmail.com
DIRECTIONS: Complete the following 3 sections and submit to your instructor so they are aware of your
service learning requirement plan.
NEED/PURPOSE: - Why is this service needed? How will it help the community?
This organization provides help for people with intellectual disabilities, such as down syndrome
and autism, and assists them with independent living which allows them to lead more fulfilling
lives where they are provided a sense of power by overseeing their own decisions.
ACTION: - What specifically will you be doing during the 10 hours at this agency?
I will be assisting in outings they will be going on for the next few weeks. This includes mostly
being a friend to people that typically only get to interact with people that also have IDD. I will also
be assisting in general maintenance on the houses that the participants live in, such as painting
their rooms and changing lightbulbs and any other tasks that are needed.
NEED/PURPOSE: - OUTCOMES: - What positive impact will this service have on the
community? What do I personally hope to gain from the experience? What evidence will I
be able to collect from the agency/contact person to verify my participation?
Having someone that is neuro-typical show them genuine interest make them feel a stronger
sense of belonging and higher self-esteem.
SIGNATURES: I have reviewed this service proposal and request to proceed. Any future changes
to this proposal must be submitted to your instructor.
The service will begin on ___10-21-18________ (approximate date)

CSN Student: Nick Bones_______________________________________________________________
CSN Instructor Approval: Robert Shkorupa_________________________________________________
Service Learning Log (10 Hours)

Complete service learning components to equal 10 hours or more. Be sure to attach specific additional
documents required by your instructor for each type of service listed below.
YOUR FULL NAME: Nick Bones

____________________________________________
Supervisor e-mail
Agency/Type of Service:
Date(s) ___10-21-18__________________________
Date(s) __10-23-18___________________________
Date(s) __10-27-18___________________________
Total Hours: __12___

Date(s) _____________________________________
Date(s) _____________________________________
___________Destiny Bones____________________
Date(s) _____________________________________
Supervisor Name (print)
Total Hours: _____

____________________________________________
Supervisor Signature
____________________________________________
__________702-443-4325______________________
Supervisor Phone
____________________________________________
___________DestinyxxBones@gmail.com________
Supervisor e-mail
____________________________________________
Supervisor Phone
____________________________________________
Supervisor e-mail
Date(s) _____________________________________
Date(s) _____________________________________
Date(s) _____________________________________
Total Hours: _____

Date(s) _____________________________________
Date(s) _____________________________________
____________________________________________
Date(s) _____________________________________
Total Hours: _____

____________________________________________
____________________________________________
____________________________________________
Supervisor Phone
____________________________________________
Supervisor Signature ____________________________________________
Supervisor e-mail
____________________________________________
Supervisor Phone
Dear Community Service Agency Representative:
The Education Department of the College of Southern Nevada is pleased that

you have chosen to partner with our pre-service teacher education program to
provide a community service learning opportunity for our students.
We are pleased to present you with CSN STUDENT _Nick Bones___________

who is currently enrolled in our EDU 280 Valuing Cultural Diversity course at
CSN. Service learning experiences help our preservice teachers be successful in
their future careers. Our faculty believes that this experience provides “real”
hands-on learning, which allows our students the opportunity to understand the
challenges and necessary problem-solving skills and needs inherent in the
community we all live.
The CSN student providing you with this letter has agreed to follow the policies of
the department and must conduct themselves appropriately while volunteering
with your agency. The Service Learning packet includes a Pre-Approval form
that was preapproved by their CSN instructor, and also a Verification Sheet.
That section is provided to the agency so the student can earn credit for their
service. The verification sheet includes agency information and spaces to log
contact hours before ultimately obtaining an agency administrator’s signature for
verification. A company letterhead correspondence is also encouraged, because
it can be included in the student’s professional portfolio.
We are confident that our students will perform well with your agency. They
understand that they are interfacing with a very busy operation, and we expect
them to represent our department and our college appropriately.
We know that from time to time issues may arise. We want you to know that you
are free to contact the CSN Instructor at any time to assure things are being
correctly managed. The following contact information is available if you find
yourself in need of assistance from CSN.
CSN Instructor: Professor Robert Shkorupa
Phone: (702) 651-4333 Email: robert.shkorupa@csn.edu

Department of Education, College of Southern Nevada
Phone: (702) 651-4400
Department Chair: Dr. Rochelle Hooks
Email: rochelle.hooks@csn.edu

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12A.

College of Southern Nevada Education Department’s

Approved Service Learning Choices

Service Learning Pre-approval (10 Hours)

Your Full Name: Nick Bones

CSN Professor: Robert Shkorupa

Agency Name: New Vista

Agency Address: 5220 W. Charleston Blvd.

Agency Phone: 702-443-4325

Agency Contact Person: Destiny Bones

Contact Person’s email: DestinyxxBones@gmail.com

The service will begin on ___10-21-18________ (approximate date)

CSN Instructor Approval: Robert Shkorupa_________________________________________________

Service Learning Log (10 Hours)

YOUR FULL NAME: Nick Bones

Total Hours: __12___

Total Hours: _____

Total Hours: _____

Total Hours: _____

Dear Community Service Agency Representative:

The Education Department of the College of Southern Nevada is pleased that

We are pleased to present you with CSN STUDENT _Nick Bones___________

CSN Instructor: Professor Robert Shkorupa

Phone: (702) 651-4333 Email: robert.shkorupa@csn.edu

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The service will begin on _10-21-18______ (approximate date)

Total Hours: 12_