ACCESS Engagement Fall 2018
SERVICE- LEARNING REGISTRATION

Welcome to ACCESS Engagement.

ACCESS Engagement develops and administers service-learning and other civic-engagement activities, projects, and programs for the college primarily – but we also run a number of large programs for the wider community, UHM in general, and other institutions of higher education.

ACCESS stands for Advising, Civic, and Community Engagement in the Social Sciences and is a vital part of the University of Hawaiʻi at Mānoa's (UHM's) College of Social Sciences (CSS) that offers services statewide.

Everyone participating in service-learning activities with us MUST COMPLETE THIS ONLINE REGISTRATION FORM and turn in a signed original of our LIABILITY WAIVER/RELEASE FORM (https://drive.google.com/file/d/1vmSww5_UaHYcePnraEYEZBGn7Yvij5Ca/view) to our office before starting service activities.

We welcome family members, guests, and others not formally enrolled as service-learning students at several of our activities and programs. They must also complete this online registration and the waiver form.

If you are under 18, or if you are bringing children under 18, please note that minors also need to be registered here and that a parent or legal guardian must sign their waiver/release forms.

If you are not a student, or not participating in service learning for credit, please write "NA" (for "not applicable") to any questions that are not relevant to you.

If you are from an institution of higher education other than UHM, you may have additional registration and waiver requirements to comply with for that institution. Be sure to check with your instructor and your institution's service-learning office.

Once you have selected a service-learning site, complete and turn in a signed site agreement/service connections form. You will probably also be asked to complete additional paperwork at your service-learning site.

Be sure to document the number of hours invested in the project with a time sheet/participation record signed by your site supervisor. See further instructions on our website: http://socialsciences.hawaii.edu/access/engagement

Email address *
First name *
Your answer
Last name *
Your answer
Student ID # (if applicable)
Your answer
Institutional email address, if different from above
Your answer
Other email address(es)
Your answer
Phone number(s) *
Your answer
Birth year *
Your answer
Gender *
Your answer
Current home institution of higher education *
Major(s)/discipline(s) *
Major(s) for undergraduate students (or: discipline(s) and degree(s) in process/acquired for other students and faculty) - if known. If not, please write "not declared" or "NA"
Your answer
For which semester or session are you registering? *
List the course(s) for which you plan to do service learning: *
Include course alpha and number with a space between: e.g. ES 333
Your answer
Service hours required *
List the number of service hours required by your instructor/assignment for each of the courses in the same order as listed above.
Your answer
Instructor(s) for whom you are doing service learning *
List the instructor(s) for whom you are doing the service learning. If you have more than one class, please list the names in the same order as the classes listed above.
Your answer
Note: Doing service learning for multiple courses
If you are doing service learning for more than one class, you MUST disclose it to our office.
There is often an opportunity to do service for more than one class at the same site. The total number of hours required will in those cases be worked out with the involved instructors at the initiative of the ACCESS Engagement Director.
Are you a returning service-learning participant? *
If yes, please give us additional information
Please list the projects/programs you were part of along with information about the courses. For instance: SHINE ES 330, Ching, Fall 2012, UHM (include course alpha/number, instructor, semester, and institution, if you can)
Your answer
High school attended
Your answer
Country of origin *
Your answer
Raised in Hawaiʻi? *
Required
If 'yes', please specify which island and location
e.g.: Hilo, Hawaiʻi
Your answer
Ethnicity - please check all that apply *
If you select "Alaska Native," "Native American," or "Other Pacific Islander," please enter specific name(s) of your people(s) under "Other" - where additional ethnicities also can be added.
Required
Learning outcomes *
Briefly describe your expected educational outcomes for participation in service learning. If you are doing service learning for multiple courses, please specify which outcomes pertain to particular courses.
Your answer
Relevant experiences and qualifications *
Briefly describe relevant experiences, skills, and qualifications that you bring to your service project.
Your answer
Pathway, program, project, and/or site, you are considering *
Select all that apply/that you are considering - and fill in additional sites or other specifics under "Other" as needed.
Required
Interested in the Mālama i Nā Ahupuaʻa (MINA) program?
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