Service Learning Materials and EquipmentApplication

For materials and equipment purchases associated with existing or proposed service learning courses

Application Deadline:December 1, 2016 at 4:00 PM

Guidelines for submitting this application can be found on the UA Service Learning website at

Complete this Microsoft Word form (adding additional pages where necessary) and email to and no later than 4:00pm on December 1, 2016

PI Name:______Title: ______

Department ______Departmental Address: ______

PI Email: ______PI Work Phone ______

Please list names, titles and departments of any co-PIs:

Name: ______Title ______Department ______

Name: ______Title ______Department ______

Name: ______Title ______Department ______

Name: ______Title ______Department ______

1.Is this request for an existing or planned course?

_____Existing

  1. Please provide course alpha, number and title below:

Alpha ______Number ______Course Name ______

  1. Please describe the course learning objectives and how service learning is being integrated to meet the course objectives and a community need. (250 words maximum)

_____Planned

Alpha ______Number ______Course Name ______

  1. ____ By checking the box to the left, you attest that your department head is aware that you are developing this course and has approved (pending proper curriculum review) that you will teach this course within the next 3 semesters.
  1. Please describe the course learning objectives and how service learning is being integrated to meet the course objectives and a community need. (250 words maximum)

2.Please explain the need for this funding and how it supports the course, course improvement or course development. (500 words maximum)

3.Complete the budget form below:

  1. Complete the table below regarding all requested purchases:

Item / Quantity
Needed / Price Per Unit / Total
Any Required Taxes*
Shipping Costs
Total (cannot exceed $1500)

* It is the applicant’s responsibility to determine which purchases are taxable by the state.

  1. Provide a budget narrative here explaining all item(s) and costs shown in the budget. (1-page maximum)

4.Provide the telephone number and email address of the department head or dean who can validate the request and officially verify the existing or planned course and service learning activity.

5.Please describe here the impact of these purchases on students including:(500 words maximum)

  • Number of undergraduate students and graduate students directly impacted by the proposed service learning activity in the upcoming semester when the course will be offered
  • Statement on extended benefits to future students

Submit all information in this word document.

Final requirements of successful applicants:

  • Submit an end-of-year impact report, including photos, to the Service Learning Initiative Co-chairs
  • Submit a blog post with photos for the Service Learning Initiative blog within a year from the initial use of the funds
  • Other guidelines will be provided at time of award

Please direct any questions to Jennie Popp () or Angela Oxford ().

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