Service-Learning Course Designation Form for New Applications and Reapprovals
This form serves as a planning and assessment tool for service-learning at VCU and as a means of ensuring the integrity of VCU’s service-learning courses. In addition to basic course and instructor information, the form gathers information about the four major components of a service-learning course: service experience, syllabus, reflection and the final evaluation.

The service-learning course designation process includes 2 easy steps:

Step 1: Complete this form.
Section 2: Email course syllabus to Katie Elliott (elliottkl@vcu.edu) immediately after you complete this form. Syllabus must include the VCU Statement of Service-Learning.

Please note that approved courses retain their service-learning designation for three years, after which we ask faculty to apply for reapproval and provide updated information. This form is used both for applications for new service-learning courses and for those seeking reapproval for an existing service-learning course that is due to renew its designation.
Section 1: Instructor and Course Information
Instructor's Name *
Your answer
Instructor's Email *
Your answer
VCU Department/Unit *
Your answer
Semester course is taught *
Check all that apply
Required
During which semester will this class first be offered as a service-learning class? *
Semester, Year
Your answer
Course Title
Your answer
Subject Prefix *
(e.g., for PADM 609, enter PADM)
Your answer
Course Number *
(e.g., for ART 302, enter 302)
Your answer
Section Number
If you know the section number, please enter it here. If there are multiple sections, separate them with commas (e.g., 001, 002)
Your answer
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