Faculty Proposal Form for CBL Course

Please use this form to provide details about your community-based learning (CBL) course.
Upon completion of this form please contact Sandi Smoker at the Ware Institute to set up an appointment with Susan Dicklitch.
Any field marked with an asterisk (*) is required!

Name * First Last
Email *
Department Name *
Course Name & Number
Please identify which semester you plan to offer your course. Spring 2013 Fall 2013 Spring 2014 Fall 2014
Is this a new course? Yes No
Total number of students you expect to enroll.
Is this course designated as a CBL seminar or a CBL-IFC in your course description? * Yes No
When does the class meet? Please include day/s of the week and time.
Short Course Description: *
What are your objectives for the community-based learning component of your course? Consider how CBL will contribute to the course's overall learning objectives. *
Do you know the community partner/s you wish to work with? Please explain. *
Is the community placement a requirement of the course? * Yes No
What is the total number of hours per week you want your students to spend in the community?
Will your students be working in groups? If so, how many groups do you expect to have?
I have reviewed the Human Subject Study and Animal Study Policies & Guidelines on the web site. * Yes, I have reviewed these guidlines No, I have not reviewed these guidlines