* Phone: * E-mail:

* Name of Class:

* Course Number:

* Meeting Days: * Time of Class:

* Class Location:

* Please enter your first and second choice for a classroom visit:
First choice: Second choice:

* Approximate number of students in class:

* Does the classroom have powerpoint capabilities: Yes No

* Are you offering community agency placements other than CS-L's: Yes No

* Is service learning optional or required:

* How is reflection used in this class:

* Are you interested in CS-L reflection resources or facilitation of reflection sessions: Yes No

Please attach your current class schedule and email it to Rich Harris.

* Denotes Required Field.