SAINT LOUIS UNIVERSITY

OFFICE OF THE VICE PRESIDENT FOR MISSION AND IDENTITY

COMMUNITY EXTENSION AND OUTREACH PROGRAMS OFFICE
NATIONAL SERVICE TRAINING PROGRAM

SERVICE LEARNING PROGRAM

I. SLU’S VMO STATEMENT

II. CORE VALUES

III. School:
IV. Course:

V. Partner Community:
VI. Profile of Partner Community:
What is the partner community? Where it is located? Who are the people in the partner community (leaders,
businessmen,)? What are the sectors present in the partner community (religion, economic, political,
education, social)? What are the needs/problems seen in the community? (these can be answered through
the rapid rural appraisal through the SLU Community Engagement System)

VII.
Matrix of Service Learning Program Activities
MATRIX OF SERVICE LEARNING PROGRAM ACTIVITIES
PROGRAM OUTCOME NEXUS ACTIVITIES COMPETENCIES PERSONS IN-
CHARGE AND
THEIR
RESPONSIBILITIES

Group Members and their Major Responsibilities:

**Suggested that there will only be 1 or 2 activities that will religiously sustained by the group and be carried on
by the next group
 VIII. Appendices
A. Plant Design / Program of Activities (Activity – Competencies – Date and Venue – Assessment)
B. Consent from Partner Community

SAINT LOUIS UNIVERSITY

OFFICE OF THE VICE PRESIDENT FOR MISSION AND IDENTITY
COMMUNITY EXTENSION AND OUTREACH PROGRAMS OFFICE
NATIONAL SERVICE TRAINING PROGRAM

SERVICE LEARNING PROGRAM

Consent from Partner Community

____________________
Date

To the University President:

May I inform your office of our willingness to enter into a partnership with (name of group)________________________, a Service
Learning Program of the National Service Training Program of Saint Louis University from _________________ to __________.

_____________________________________ _____________________________
Signature above Printed Name Designation

_____________________________________
Community/Baranggay/Organization

Contact Information:
Address: _____________________________________________________________________________________________________________
CP/Landline: _________________________________________________________________________________________________________
Email Address: ________________________________________________________________________________________________________
 C. Budget Proposal

SAINT LOUIS UNIVERSITY

OFFICE OF THE VICE PRESIDENT FOR MISSION AND IDENTITY
COMMUNITY EXTENSION AND OUTREACH PROGRAMS OFFICE
NATIONAL SERVICE TRAINING PROGRAM

SERVICE LEARNING PROGRAM

BUDGET PROPOSAL

NEXUS ACTIVITIES MATERIALS NEEDED BUDGET SOURCE OF BUDGET

Approved by:

_______________ ____________________ ___________________ _______________________

Facilitator, NSTP Coordinator, NSTP Director, NSTP VPMI

IX. Impact Assessment

**The group will plan and prepare appropriate assessment for learning competencies of each activity.

X. End-of-Activity Report
**500-word summary report of the conducted activity (intro (who, what, when where-identified
problem (why)-activity/method/conducted intervention(how) – impact assessment result) / Century
Gothic / 12 font size / single spaced
** 2-3 best pictures (2 working and 1 group picture
** 1soft copy and 1 hard copy
 End-of-Activity Report

TITLE OF ACTIVITY
*Course / School

************************Report

Pictures