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 3^nd 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