Application for Designation of EXPERIENTIAL LEARNING

Application for Designation of EXPERIENTIAL LEARNING
CO-CURRICULAR EXPERIENCES
Instructions

Please answer the following questions and provide the following information for the experience you are proposing to meet Experiential Learning requirement.
Experience Title*
(e.g. Resident Assistant, Peer Minister, etc.)
Department/ Office: *
Supervisor/ Advisor: *
Provide a brief description of the proposed experience:*
Please attach the Experiential Learning Co-Curricular Activity Description document. For access to the document, click link below.*

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- Experiential Learning Co-Curricular Activity Description
Please attach any additional documents that will help reviewers understand this opportunity (e.g., assessment tools, timelines or schedules, exit interview questions, survey questions, etc.).

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For the two questions below, please verify:

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

2) This experience includes at least 5 opportunities for reflection in a 16-week semester.

For each, active engagement and reflection, please indicate the page number(s) where this is found in the Co-Curricular Activity Description.

If needed please consult the following resources:
Yes, at least 20 hours of Active Engagement are included in this experience.
How is Active Engagement integral to the experience?
Yes, at least five opportunities for Reflection are integrated into this experience.
How is Reflection integral to the experience?

Please verify that each of the following Experiential Learning outcomes is integrated into the experience(s). At the end of this course, students will be able to . . .

Rows	True?
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.

NOTE: Reflection can be used as a form of assessment.
How will students be asked to IDENTIFY CONNECTIONS between this learning experience and past or present learning experiences?
What tool/ measure will be used to assess this outcome (e.g., a rubric, a score, or some other measure)? NOTE: Reflection can be used as a form of assessment.
How will students ARTICULATE THEIR PERSONAL RESPONSE to the learning experience (for example, an examination or expansion of one's own attitudes, feelings, values, knowledge, or skills)?
What tool/ measure will be used to assess this outcome (e.g., a rubric, a score, or some other measure)? NOTE: Reflection can be used as a form of assessment.
How will students describe how they ANTICIPATE APPLYING what they have learned?
What tool/ will be used to assess THIS outcome (e.g., a rubric, a score, or some other measure)? NOTE: Reflection can be used as a form of assessment.

Instructions

Please provide a brief Assessment Plan for each outcome listed.