De Anza College Child Development and Education Department
CD 12 “Make a Difference Project”
Field Experience Agreement
Instructor/Student
This agreement is between Li Wei Sun, Instructor and ________________________, CD 12 Student.
Description: Field/Volunteer experience for Child, Family and Community Interrelationships, CD12, at_____________________________________,
located at ___________________________________________________.
My immediate supervisor is _____________________________________.
My supervisor’s contact number __________________________________.
This experience consists of volunteering in a community organization. This is your lab experience. Keep a journal of the experience. The journal requires students to use critical thinking about their experience working in a community organization and how organizations such as the one you will be volunteering support families and society.
Student’s responsibility:
Select community organization
Attend all required hours, 12 hours for the quarter
Maintain a timesheet
Keep a journal- one page for each visit
Discuss placement matters with instructor if necessary
Duration: minimum of 2 hrs per week, beginning the 3nd week of school and ending no later than the 10th week of school.
Entered on this _______ of the month of _________________, 200___.
Executed by:
___________________________ Li Wei Sun
Student’s name Instructor’s name
________________________ ________________________________
Student’s signature Instructor’s signature