4/13/2016 Summer Institute Course Development Grant - $1000

https://docs.google.com/forms/d/1EnHQBBUfaRrtd09mgAg7VkkcU1_Fjn_a1tUWjXKwtLs/edit?usp=drive_web 1/4

Summer Institute Course Development Grant ­$1000The purpose of this grant is to support one faculty member in revising a current course to reflect service learning pedagogy for the 2016 – 2017 academic year.

There are 3 components to this grant: If awarded, recipients are expect to1) attend a course development workshop at the Community Engagement Summer Institute in June 2016; 2) teach the service­learning course in fall 2016 or spring 2017; and 3) choose a student scholar.

The service­learning project must be developed in collaboration with a community­based organization, provide a meaningful service­learning experience for students, and fulfill a need defined by the community organization. Funded faculty are required to implement and complete the service­learning project during the 2016 – 2017 AY.

DUE: Friday, May 6, 2016, by 5 PM.

* Required

DirectionsPlease complete all sections of the application below, incomplete application will not be reviewed. Completed applications include all material and necessary signatures.

1) Submit an electronic application using this form. 2) Download the signature form found at the end of this application. 3) Submit the completed signature form to our office by emailing a copy to communityengagement68@csun.edu.

Completed application are due by Friday, May 6, 2016 at 5:00 PM

Applicant Information

1. Your name *

2. Your faculty ID number *

3. Your email address *

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4/13/2016 Summer Institute Course Development Grant - $1000

https://docs.google.com/forms/d/1EnHQBBUfaRrtd09mgAg7VkkcU1_Fjn_a1tUWjXKwtLs/edit?usp=drive_web 2/4

4. The name of the community partner youplan to work with (for a list of all approvedorganizations please visithttps://app.calstates4.com/csun/sites)

5. Please list any other source of internal orexternal funding for this project, includingany other travel funding.

Course Information

6. College *

7. Department *

8. Course title *

9. Course subject and catalog number(ex. ACCT 492)

10. Course Number( ie. 5 digit code)

11. The term you plan to teach the courseMark only one oval.

Fall 2016 Skip to question 12.

Spring 2017 Skip to question 12.

Both Fall and Spring

Narrative

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4/13/2016 Summer Institute Course Development Grant - $1000

https://docs.google.com/forms/d/1EnHQBBUfaRrtd09mgAg7VkkcU1_Fjn_a1tUWjXKwtLs/edit?usp=drive_web 3/4

12. In a few sentences, state your overall goals for including a community service­learningproject as an integral aspect of the course. Include specific student learning outcomesthat you expect to see enhanced through community service­learning and the type(s)of community impact you expect to achieve through the service­learning project. *

13. In a few sentences, describe the proposed service­learning project idea (20­45 hours);how it involves students in a substantive, ongoing learning activity directly integratedand related to the curriculum, what community need it addresses, and identify the roleof the community partner as co­educator for the course. *

14. What, if any, plans do you have for assessing student learning outcomes or forsustaining this course beyond the first semester that you teach it? *

15. List any community partners you might engage with. Please feel free to see ourapproved partner list here:https://app.calstates4.com/csun/sites *

Supporting documentsPlease copy a draft of your existing course that you wish to provide, and please email the signature form from your department chair to communityengagement68@csun.edu.

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4/13/2016 Summer Institute Course Development Grant - $1000

https://docs.google.com/forms/d/1EnHQBBUfaRrtd09mgAg7VkkcU1_Fjn_a1tUWjXKwtLs/edit?usp=drive_web 4/4

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16. Syllabus *You may copy and paste your syllabus here and/or email a copy to our office along with yourcompleted signature form.

17. Please email the signature form (found here:https://drive.google.com/file/d/0B78Mam68Mgd1cnVUQVlrWVZxczg/view?usp=sharing)to communityengagement68@csun.edu. *Check all that apply.

I have emailed the signature form (found above) tocommunityengagement68@csun.edu.

I understand that if I am awarded this grant, I will attend a 2­day workshop at theSummer Institute on June 1 and 2, 2016.

I understand that if I am awarded this grant, I will be expected to utilize the ServiceLearning Database and all designated Community Engagement forms when teaching theservice learning course above.

I understand that this award is taxable.

I understand that I will have to complete a short report in May 2017 to state anyoutcomes of this award.

In lieu of an electronic signature, I check this form to certify that all of the aboveinformation is true.

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