Application for Designation of EXPERIENTIAL LEARNING

Application for Designation of EXPERIENTIAL LEARNING
COURSE
Instructions for Faculty and Staff

Faculty and staff completing this form should answer the following questions and provide the following information for the course being proposed to meet the Experiential Learning requirement. PLEASE NOTE that all sections in all modalities of an approved Experiential Learning course MUST meet the proposed and approved student learning outcomes and must adhere to the proposed and approved assessment plan.
Course number and course title (e.g., CHEM 111000: General Chemistry 1 Lab) as listed in the course catalog. Click "submit" after typing the necessary information. *
Catalog description of course:*
Please attach a course syllabus:*

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Please attach any additional files you believe should be included:

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For the two questions below, please verify:

1) This course provides at least 20 hours of active engagement in a learning experience during the semester.

2) This course includes at least 3 opportunities for reflection for an 8-week course OR 5 opportunities in a 16-week course.

For each, active engagement and reflection, please indicate the page number(s) where this is found in the course syllabus.

If needed please consult the following resources:

Rows	True?	Syllabus Page Number(s)
Active Engagement (e.g., 20+ hours)
Reflection (e.g., 3 opportunities for an 8-wk course, 5 opportunities for a 16-wk course)

Please verify that each of the following Experiential Learning outcomes is integrated into this course. Please indicate where each outcome is listed in the syllabus. At the end of this course, students will be able to . . .

Rows	True?	Syllabus Page Number(s)
identify connections between this learning experience and past or present learning or experiences.
articulate their personal response to the learning experience(s) (for example, an examination or expansion of one’s own attitudes, feelings, values, knowledge, or skills)
describe how they anticipate applying what they have learned.

Please provide a brief Assessment Plan for each outcome listed above. Please note that REFLECTION can be used as an assessment tool.
SLO 1. At the end of this course, students will be able to identify connections between this learning experience and past or present learning or experiences

.
Students will be asked to demonstrate SLO 1 by . . .(Be specific: what is the evidence [assignment, project, reflective question, etc.] that will be collected?)
What tool/ measure will be used to assess student learning for SLO 1 (e.g., a rubric, a score, or some other measure)? Please indicate where this tool/ measure is found in the syllabus or other attached document.
SLO 2. At the end of this course, students will be able to articulate their personal response to the learning experience (for example, an examination or expansion of one’s own attitudes, feelings, values, knowledge, or skills)
Students will be asked to demonstrate SLO 2 by . . .(Be specific: what is the evidence [assignment, project, reflective question, etc.] that will be collected?)
What tool/ measure will be used to assess student learning for SLO 2 (e.g., a rubric, a score, or some other measure)? Please indicate where this tool/ measure is found in the syllabus or other attached document.
SLO 3. At the end of this course, students will be able to describe how they anticipate applying what they have learned
Students will be asked to demonstrate SLO 3 by . . .(Be specific: what is the evidence [assignment, project, reflective question, etc.] that will be collected?)
What tool/ measure will be used to assess student learning for SLO 3 (e.g., a rubric, a score, or some other measure)? Please indicate where this tool/ measure is found in the syllabus or other attached document.

Instructions for Faculty and Staff

Please provide a brief Assessment Plan for each outcome listed above. Please note that REFLECTION can be used as an assessment tool.

SLO 1. At the end of this course, students will be able to identify connections between this learning experience and past or present learning or experiences

SLO 2. At the end of this course, students will be able to articulate their personal response to the learning experience (for example, an examination or expansion of one’s own attitudes, feelings, values, knowledge, or skills)

SLO 3. At the end of this course, students will be able to describe how they anticipate applying what they have learned

NOTE: The following is for administrative purposes only and will not be used in determining approval of the proposal.