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SP - Organization Placement Application Form


Thank you for your interest in having CBC students volunteer with your organization. Please complete the following form and contact us if you have any questions or concerns.

Required fields are marked with an asterisk (*)
 
Name of Organization *
 
Contact person/supervisor *
 
Alternate contact or other supervisor (if necessary)
 
 
Mailing Address *
 
City *
 
Postal or Zip code *
 
Phone Number (main contact) *
() -
 
Email Address (main contact) *
 
other contact information (if necessary)
 
 
Title of Position Available *
 
Job Description *
 
Number of students needed *
 
Gender Preference (if any)
 
Day of week *
 
Time of day *
 
Total hours/week *
 
Transportation *

(You may select more than one option)
 
Specific skills required (please specify if any) *
 
 
Training or waiting period required
Yes No
 

If yes, please comment
 
Criminal record check required (please note: CBC recommends criminal record checks for all students working with minors and persons with special needs.) *
  Yes No
 
Interview Required *
Yes No
 
Please post this position until *
 

Organization/Supervisor Responsibilities:

1. Provide the student with at least 2 hours of experiential learning each week. The student should be working with or providing a service to people if at all possible. This will provide the student with valuable service practicum experience. Students should be given clear expectations and responsibilities.

2. Be available to the student(s) for supervision and encouragement throughout the semester, and meeting with them 2 times each semester, once during mid-term and once to discuss the final evaluation, which, combined with the student’s attendance, is worth 40% of the student’s Service Practicum grade. The College, through the student, will provide this evaluation form later in the semester.

3. Inform student(s) of cancelled assignments in advance if at all possible.

4. Enable the students to adhere to the following guidelines to avoid any potential for misconduct.
a. When working with children/youth, CBC students should have another adult or student present if at all possible.
b. Students should only mentor same gender.
c. CBC recommends that organizations require a criminal record check for all students working with children, youth or persons with special needs.

5. If a criminal record check or training is required of student(s) please indicate this on the application form and be willing to cover any related costs. The college is not responsible for any costs related to organizational requirements. Any costs to be covered by the student must be made clear to the student before they agree to participate in your program.

6. Strive to resolve any concerns that may arise in the student’s relationship with other staff, volunteers or you as the supervisor. The Service Learning staff should only become involved if the concerns persist.

Attendance:
Students are expected to invest 2-3 hours per week over the course of the semester. It is possible to design a placement as a more concentrated service assignment, if applicable

We expect students to be faithful in keeping their commitments as volunteers. If you note a student frequently missing a commitment that is not due to an illness, hazardous travel conditions, or because of a required College function, please contact the service learning office.

Semester dates for Service Practicum:
The placements generally run for a year; there is a break between fall and spring semesters.
• Fall semester: September 24, 2010 – December 13, 2010
• Spring semester: January 18, 2011 - April 15, 2011

2010/2011 College dates off (These would be College required functions or holidays)
• Urban Mission Adventure (1st year students) one of:  Sept. 30 - Oct. 3, Oct 28-31, Feb. 3-6 or March 3-6
• Thanksgiving - Oct 11
• Remembrance Day – November 11
• Reading Week - February 19-27

I have read and agree to the above responsibilities as a potential Service Practicum supervisor:

*
  Yes No
 
I have received and read the Supervisor Manual for Service Practicum: *
  Yes No
 
Please send me a copy of the Supervisor Manual: *
  Yes No
 
Form Completed *
A copy of this form will be sent to your email address; if you do not receive a copy to your email address, please contact Christy Brown (Christy.Brown@columbiabc.edu).
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