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Fall Spring First Summer Second Summer Year
Course: ________Section Number: ____________Hours Required: ______________
Name ________________________________________________________
Date: ___________________
Community Site: _______________________________________________________
Address: _____________________________________________________________
Site Supervisor: _______________________________ Phone: ______________________
Student's Duties: ___________________________________________________________
Days and Hours of Service
The Community site agrees that the above named student accepted by it for volunteer service will in no manner be considered to be an employee, agent, or volunteer of Glendale Community College and that the volunteer relationship which is established will be solely between the Community site and the student. Any screening for suitability for volunteer service is the responsibility of the Community site and not the College. The College makes no warranty of suitability for service of students volunteering with the Community site.
The Community site will hold the College harmless from all claims or actions which may arise by reason of volunteer service being provided to the Community site by the student.
I AGREE TO ACCEPT THE STUDENT NAMED ABOVE AND PROVIDE ADEQUATE SUPERVISION AT THIS SERVICE-LEARNING SITE.
SITE SUPERVISOR'S SIGNATURE: _____________________________DATE: ______________
*Complete this form with the site supervisor/volunteer coordinator at
time of placement. Return completed form to course instructor.
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Direct feedback to: Randy
Kimmens
URL: http://www.gc.maricopa.edu/servicelearning/fconfirm.htm
Last update: Wednesday December 20 2000