Service Learning Site Placement Form Ivy Tech Student Name Lode Sefbaies Date 2) BIS Professor: é . \ M4 i g Class: EDUC 161-Introdcution to Teaching Site Information SchooVEnstitution stores, ROSE Lowtlle dymntrecerry aaares_ 3 4Alo Rowse velt Ave. zt AQ. Supervision Teacher’s Name 1 Site Phone )2ai-4as) Grade/Content Area, a Location/Room 126 eiairoe ame ID A a -]2: aria u Service Learnis Ent wae}/3 7] a ws Email Efe mn © my ipso ee ‘Supervision Person’: a: 2. ) GY6-. sat. i Consent Information Igive Ao e defhares. ~ (vy Tech Student) permission to ' complete 10 Service Learning hours at my schooVinstitution as they fulfill their 8 week — 16 ‘ hour Service Learning course requirement. Principal/Supervisor Signature : Date G/B fer ‘Supervising Person Signature. Iw Tech School of Education 013F Form 1 mf Ss APPLICATION TO PROVIDE VOLUNTEER SERVICES. 120 E. Walnut Streot, RM 103 | indianapolis, Indiana scam Please ist the school(s) you would like to volunteer at (eqieeo* “Hive ~OBERIES EAI LE Le. wooness: 1121 OLD HOUSE RD ow JNDPLS sme JA raunowe 311-340-1470 oYaq/is%0 er Puss aces checkinthe box mato your eaten: C]Pennt/GuarsenctentPSenia (Gage Saert_(CarvralrpszatonVlurioa Crates cretree Carmen Clover sonst sorgseansecsaut wi ECR Copamoniry Cole ee a 489 et ‘Paste cle your volunteer proferace(e: Medi Center ‘cade Ter PrArPTO ast Ate oe Pare Outdoor Etucaton ‘ont Ase corer Schod Oe Litera tgand cnet rioa ortnnrowamceand aftr tnt PS a NPS EPUC I) Wud [key be an- 2 VOLUNTEER CONSENT AND RELEAGE STATEMENT: PLEASE READ CAREFULLY BEFORE SIGNING | carat tat th information contsined inthis applcaton as submited is tus, complete, and accurate to the best o ited es part of my appation to provide v wl be cause for dequsiication. ‘aquired to submit to a ering! history nd check as condition for consideration for voluntoer er Woceeptod as Ve consent ‘and agree to abide bythe polis, rules and regulations f the Goard of School Cormmislonars of te Gio ncanopo, ad fo comply wih ad abide by such har rs, rogustons, and crctons oft Pepa, es rpoyes luncentand hath ndenapa Pe Scho et respra fy yoy propery hy pron wha a ang a Von. Thereby wave, ‘nolo ue, éndctherve hod IPS, ts ofcrs and employees harmless fom and agains ny and i aa urtermor release, covenant not eu. x rtsbiniog fay nae wnatsonver nat mght se ass rare my worse Vanes ra indanepens Puc Sa Se eeaaergE ay 2 eae Y23)13_ 'HOTIFY W CASE OF EMERGENCY: (Moga Roses, —_ [fds N Tuxedo 317 -FB5-5 188 7- Vosilcheck Community 317-03) For Principata Use Only: canpiats te folowing hvomalon na criminal Nistor Is required Principats Signature Date, ‘School #Location. "Signals sigalon sazompton ofa Bi /ERSE SIDE OF FORM FOR DIRECTIONS ON OBTAINING AND SUBMITTING A CRIMINAL HISTORY Please check here if you already have a criminal history on file for the 2014-15 school year and you are only adding a school REVISED 0172015; Service Learning Log Sheet i Name:_Katie Jeffries Date Submitted:_12/2/15, ; Service Learning Site:_IPS 5} E | Teacher:_Miss Maura Renzi Total Points Earned 150 i Date Time Time | Hours Teacher’s Signature 1 9/29/15 In Out | per Day 10:35 | 12:06 [1.5 hrs UY eC 10/20/15 | 10:25 12:05 1.5 hrs 10/23/15|10:35 [12:35 | 2.0hrs KEE, se 10/30/15 | 10:45 [12:45 | 2.0hrs Gi Le 11/3/15 [10:32 [12:30 |2.0hrs 11/s/as j9:55 [43:35 | 1.5 hrs 11/6/15 |10:45 [12:30 | 1.75 hrs YW : 11/10/15 | 10:44 (42:35 (| 4.75 hrs 11/12/15] 10:05 [12:33 |2.5hrs WIECH | 11/17/15 (10:37 iad |g ohesTotal Hours 18.5 Yours 10 points will be awarded for each hour completed in the field, but will not exceed 160 points. Student must complete hours within the time frame assigned in the course calendar. Student must visit school/teacher for 16 hours at 2 minimum of 4 separate visits to receive full credit.EDUCATION 101 Service Learning Activity Checklist Student’s Name:_CKatie Jefiries___ Teacher's Name;__Maura Renzi Points___/30 All of the following routines, procedures and duties arc important to the management of the instructional environment. Students will need to learn to complete these tasks while simmltaneously teaching the class. Service Learning Students will need to become familiar with the process of multitasking efficiently by completing 20 of the-4S tasks listed in the. chart below. Record the dates the tasks were completed and have the teacher initial at the end of eath weekly visit. This cchart will be submitted at the end of the semester with the Final Service Learning Report. This Service Learning requirement is not supposed to be used to pressure supervising teachers into creating new jobs for Service Leaming Students to perform. Many of these tasks simply may not be applicable to your site location. Also, ‘many of these jobs may be routine procedures repeated weekly. If this is the case, only mark the first date the task was completed. Three blank lines are labeled other at the bottom of the chart for new/unusual duties. Activity ‘Date ‘Teacher's Completed Initial 1. Make a seating chart 2, Take Attendance wens Fp; 3, Run errands for the teacher 1oR0/15 4 Help with general classroom housekeeping TANS ZA 5. Organize materials fora lesson TOROS 6 Make copies ToR20/I5 7, Arrange a bulletin board wes | / 8. “Check out books ffom the library “ 9. Research media materials to be used in the classroom 10. Make a chart or graph applicable to the classroom TI. Greate an art project or craft for the class to do 12, Setup a DVD of Visual Clip Ge. YouTube), ete. 13. Gather supplemental materials for a lesson (magazines, articles, maps, cic.) 14, Develop a bibliography for an upcoming unit, 15. ComrectGrade papers 1070715 T6, Set up/Assist with a lab, experiment or demonstration 17, Setup a Learning Center Tiio7is 18. Write a daily news announcement 19, Arrange for a guest speaker 20, Help organize a field wip 21, Plan/Gather materials for a class party or playoe 22. Help make costumes for a class party or play a Date ‘Teacher's Activity Completed Initial 23. Send out a newsletter/communication to parents 24. Observe students 9729/1S 25. Create a PowerPoint for one of the units 0 the teacher will have a resource 26, Read to the students TiAns 27. Tutor students one on one in a subject area, (Le. math, reading, ete.) ‘ORI 28. Attend a faculty meeting or other faculty planning meeting 29. Work with students in a small group 972915 30. Help students who have been absent get caught up 31. Make up a test or quiz: 1030/15, 32. Lead stadents to or from the classroom ( transition) TOB0/I5 33. Create a display of the student’s work TA2AS 34, Help students review fora text or quiz ToRanis 35. Help supervise students at lunch or recess 10/23/15 36. Teagh a simple lesson plan 37. Present a short Autobiographical Introduction to the class 9RINS 38, Distribute or’Collect student’s papers 39. Assist with a lesson or lesson plan ‘40. Take a lunch count W/2S, 41. Attend a Parent/Teacher conference 42. Attend a Back to School Night or Open House 43. Other: Help students solve technology issues TOROS 44. Other Fi wed Copy Mocnae Tt] 6| f 45. Other Comments Wet 2p Date Completed