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Experiential Learning Report Form Part A (Planning)

This document outlines the process for experiential learning at Knox College. It is completed in three stages: 1) developing a plan that is approved by a faculty sponsor; 2) completing at least 40 hours of an internship, community service, research, or other experience; 3) writing a reflective essay. Part A is filled out before the experience to outline the plan. Part B is completed after to reflect on what was learned and how the experience impacted academic and personal growth. Students evaluate how valuable the experience was and whether it provided direction for their future.

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70 views4 pages

Experiential Learning Report Form Part A (Planning)

This document outlines the process for experiential learning at Knox College. It is completed in three stages: 1) developing a plan that is approved by a faculty sponsor; 2) completing at least 40 hours of an internship, community service, research, or other experience; 3) writing a reflective essay. Part A is filled out before the experience to outline the plan. Part B is completed after to reflect on what was learned and how the experience impacted academic and personal growth. Students evaluate how valuable the experience was and whether it provided direction for their future.

Uploaded by

jfdooley3106
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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EXPERIENTIAL LEARNING REPORT FORM

OFFICE OF THE REGISTRAR

Part A (Planning)

INSTRUCTIONS: At Knox, Experiential Learning refers to learning that occurs through intentional and planned activities outside the traditional classroom which can contribute to professional and/or personal growth. The project is completed in three stages: 1) a plan, developed in advance and approved by the faculty or staff project sponsor; 2) the project itself, involving at least 40 hours of activity; 3) a reflective essay written at the conclusion of the project. Part A of this form should be turned in to the academic advisor (or other sponsor) prior to the experience. Both parts A and B must be submitted to the Office of the Registrar after completion of the project. Students who enter Knox after significant adult work experience that seems appropriate as Experiential Learning may talk with their advisor about working on a retrospective reflection.

This part of the form is to be filled out prior to the experience Todays Date: ____________ Student ID#:_____________ Dates of Experience: _____________

Student Name: _________________________

Term and year of your expected graduation ____________________ Academic Advisor Name: ______________________________ Sponsor Name (if different from advisor): ______________________________ Type of experience (select one): Internship Work experience Community service Off-campus study: Name of program__________________________ o Study abroad o Study in the U.S. Independent research/creative work Teaching assistantship Campus leadership experience Other experience (please specify) _____________________________

Brief description of planned experience:

What was your primary reason for choosing this experience? (select one) Academic/professional growth Personal growth Intellectual curiosity What are your objectives in participating in this experience?

Authorizing signature of student: ______________________ Date: _________ Authorizing signature of sponsor: ______________________ Date: _________

EXPERIENTIAL LEARNING REPORT FORM


OFFICE OF THE REGISTRAR

Part B (Reflection)

This part of the form is to be filled out after the experience Student Name: _______________________ Student ID#:_______ Dates of your experience: From _____________ to _____________

Provide a brief description of the experience (ca. 150-250 words).

How valuable was your experience to your academic/professional growth? Not at all valuable Somewhat valuable Moderately valuable Very valuable How valuable was your experience to your personal growth? Not at all valuable Somewhat valuable Moderately valuable Very valuable How valuable was your experience to your intellectual development? Not at all valuable Somewhat valuable Moderately valuable Very valuable

To what extent has the experience helped provide you a sense of direction for your life after Knox? Not at all helpful Somewhat helpful Moderately helpful Very helpful Reflect on how the experience went, what you learned from it, and how it may influence your future academic or personal life. Some things you might consider include: What was the most valuable part of the experience? What difficulties did you face and how did you respond to them? To what extent were your expectations going into the experience met? What previous experience or study contributed to the success of your experiential learning project? Was there any additional preparation that would have been useful? If you were doing this again, what might you do differently? (ca. 500-750 words).

Authorizing signature of student: ______________________ Date: _________ Authorizing signature of sponsor: ______________________ Date: _________

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