Course Designation Application

Instructor's First Name:

Instructor's Last Name:

4-Digit Course Code #:

5-digit CRN # (if known):

Course Title:

Credit Hours:

ACE this course as a face-to-face classroom section?
Yes    No

ACE this course as an online classroom section?
Yes    No

Department:

College:

Course is offered by this instructor (Please fill in the year you will be offering the course and the number of sections within each semester): Fall       # of Sections
Spring       # of Sections
Summer 1       # of Sections
Summer 2       # of Sections

Please check appropriate response.
Note: You may have a combination of "YES" and "NO" responses.

1) For every 1 credit hour, will each student complete at least 3 hours of community engagement? (In other words, for a 3-credit course, will students complete a minimum of 9 hours of service in the community?
Yes    No
Page Number on the syllabus:

2) Is community engagement linked (specific or implied) to one or more course objectives and/or learning outcomes?
If yes, please highlight in the syllabus.
Yes    No
Page Number on the syllabus:

3) Are students required to turn in a written reflection (project, report, journal, etc.) about the community engagement experience? Yes    No
Page Number on the syllabus:

4) Is the community engagement experience a part of the student's overall grade? Yes    No
Page Number on the syllabus:

5) Does the syllabus include (or would you include) a statement on the impact of the community engagement experience?
For example: "Community Engagement: In this course, you will not only learn knowledge and skills, but also actively use them to make a difference in our community to improve the quality of life. This experience, it is hoped, will help you see yourself as a positive force in this world and deepen your understanding of your role as a citizen."

Yes    No

Please copy your statement on the impact of the community engagement experience:

6) Who identifies the community partners? Self    Student

7) Will you solicit written feedback from your community partner(s)? Yes    No

Your idea to ACE this course must be approved by your Chair. Do you have your Chair's approval?
Yes    No

Department Chair's Name:

Please attach tentative syllabus of this course which is highlighted as per above. (There is no need for inclusion of class schedule, reading list, university policies, etc.).

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