4/13/2016 Community Engagement Student Scholar Grant - $500 (per semester)

https://docs.google.com/forms/d/1SNhGffMbjetgIBsFFBra5sCnYf0jfIdnFzihh0C59wM/edit?usp=drive_web 1/4

Community Engagement Student Scholar Grant ­$500 (per semester)The purpose of this grant is to support one faculty member and a student scholar in disseminating research and/or service during the 2016 – 2017 academic year. There are 4 components to this grant: If awarded, recipients are expect to 1) attend a course development workshop at the Community Engagement Summer Institute in June 2016; 2) teach the service­learning course in fall 2016 or spring 2017; 3) choose a student scholar; and 4) utilize the Service­Learning Database and all designated Community Engagement forms.

The service­learning project must be developed in collaboration with a community­based organization, provide a meaningful service­learning experience for students, and fulfill a need defined by the community organization.

Funded faculty are required to implement and complete the service­learning project during the 2016 – 2017 AY.

DUE: Friday, May 6, 2016, by 5 PM.

* Required

DirectionsPlease complete all sections of the application below. Incomplete application will not be reviewed. Completed applications include all materials and necessary signatures.

1) Submit an electronic application using this form. 2) Download the signature form found at the end of this application. 3) Submit the completed signature form to our office by emailing a copy to communityengagement68@csun.edu.

Completed application are due by Friday, May 6, 2016 at 5:00 PM

Applicant Information

1. Your name *

2. Your faculty ID number *

3. Your email address *

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4/13/2016 Community Engagement Student Scholar Grant - $500 (per semester)

https://docs.google.com/forms/d/1SNhGffMbjetgIBsFFBra5sCnYf0jfIdnFzihh0C59wM/edit?usp=drive_web 2/4

4. Name of your student scholar (if known)

5. Student ID of your student scholar (ifknown)

6. The name of the community partner youplan to work with (for a list of all approvedorganizations please visithttps://app.calstates4.com/csun/sites) *

7. Please list any other source of internal orexternal funding you are receiving for thisproject, including any travel funding. *

Course Information

8. College *

9. Department *

10. Course Title *

11. Course subject and catalog number(ex. ACCT 392)

12. Course Number( ie. 5 digit code) ­ If you are unsure of thenumber, please include "N/A"

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4/13/2016 Community Engagement Student Scholar Grant - $500 (per semester)

https://docs.google.com/forms/d/1SNhGffMbjetgIBsFFBra5sCnYf0jfIdnFzihh0C59wM/edit?usp=drive_web 3/4

13. The term you plan to teach the courseMark only one oval.

Fall 2016 Skip to question 14.

Spring 2017 Skip to question 14.

Both Spring and Fall

Narrative

14. Provide a brief description of your service learning project. *

15. Briefly describe how you will use your student scholar to implement your project. *

Supporting documentsPlease copy a draft of your existing course that you wish to provide.

16. Syllabus *You may copy and paste your syllabus here and/or email a copy to our office atcommunityengagement68@csun.edu along with your completed signature form.

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4/13/2016 Community Engagement Student Scholar Grant - $500 (per semester)

https://docs.google.com/forms/d/1SNhGffMbjetgIBsFFBra5sCnYf0jfIdnFzihh0C59wM/edit?usp=drive_web 4/4

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17. Please email the signature form(https://drive.google.com/file/d/0B78Mam68Mgd1cnVUQVlrWVZxczg/view?usp=sharing) to communityengagement68@csun.edu. *Check all that apply.

I will email the signature form (found above) to communityengagement68@csun.edubefore April 29 at 5pm.

I understand that student scholars are not teaching assistants and cannot gradecoursework.

I understand that student scholars must be enrolled as students during the semesterthat they serve as my scholar.

I understand that this is a multistep application. In addition to submitting this online form,I will email the below signature form to communityengagement68@csun.edu before April 29at 5pm.

I understand that if I am awarded this grant, I will attend a 2­day workshop at theSummer Institute on June 1 and 2, 2016.

I understand that this award is taxable.

I understand that this funding will be processed as an award for the student and doesnot count towards his/her employment hours at CSUN.

I understand that I will have to complete a short report in May 2017 to state anyoutcomes of this award.

In lieu of an electronic signature, I check this form to certify that all of the aboveinformation is true.

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