Request for In-class / Out-of-class ACE Reflection Session

Please turn this request in at least a month prior to the requested date of the reflection session.

Note: all fields are required. If problems persist, email equivalent information to iubosl@indiana.edu.

Today's Date November 7, 2009
Contact Information
Name
Department
Phone
Email
Class Information
Course number
Course name
Room number

Number of students in class
Please briefly describe your course objectives, the service students performed and how you envision the two meet
Reflection Session Information
Date
Start Time
End Time
Preferred reflection session location (choose in-class or on-site at agency)

In-class location

Community partner agency
Do you have any specific or guiding reflection questions or format you would like the ACEs to utilize?
Preferred number of ACEs to lead reflection