Faculty Name

Email

Department

Name of Course

Semester/Year of Course

Brief Course Description

This course includes the following components:

Public Scholarship
Community-Based Research
Community-Based Learning
Policy/Political work
Internship/Practicum integrated into class
Other

Describe idea for civic engagement component(s):

List potential community stakeholders:

How will community stakeholders benefit from the civic engagement component(s)?

How will students benefit from civic engagment component(s)?

Administrative or academic support that you would like: