SPONSOR Report Form

Civic Engagement

(To Be Completed by Co-Curricular Sponsor)

Southwestern Oklahoma State University

This report form is designed primarily for organization sponsors or officers designated to furnish data. Sponsors may be either faculty or staff. Projects which have been done in connection with an academic class, but not meeting all criteria of a Service Learning Project, may be reported on this form, as well.

This form reflects all club/organization service projects completed during an academic year. Data will be reported to State and National Campus Compact, as well as the SWOSU campus and constituents.

DUE DATE: At the end of each semester.

Name*

First Name

Last Name

Your Title*

Faculty Staff Student Officer

If the sponsor is faculty, how many staff (non-faculty) have also been involved in support of the project?*

Email*

Academic Year*

Name of Club, Professional Organization, Service Group, or Class*

College*

Arts & Sciences Pharmacy Professional & Graduate Studies Associate and Applied Programs Not Applicable

Department (if applicable)

Community Partner Contact Person*

First Name

Last Name

Community Partner's Organization

Community Partner Contact Phone*

Semesters of Service:*

Fall Spring Both Summer

Type of Service Project*

One-time only Continuing

Number of students participating:*

Estimate the average number of TOTAL hours each student spent on this project.*

Provide a brief description of the project (community need identified, service provided, duration of project, etc.):*