NOTE:

Sample form only - not for submission.

*denotes mandatory fields
Details of Western Sydney University contact for this activity (your details appear automatically once logged in)
Research centre / institute
select if applicable
Can you nominate one other staff member to update this activity data?
If yes, enter surname, press 'Search Surname' and 'Select'.
Please list all other Western Sydney University staff involved in this activity.
Enter surnames, press 'Search Surname' and 'Select'.
Activity details
Name of activity
*
Location of activity
(Please select all local government areas that apply) *
   


(Please specify) *
   





(Please specify) *






International
select which applies
What is the main purpose of the activity? (Please select one) *


What best describes the primary focus of your activity in terms of segments of the community involved? (Please select all that apply) *






















Please describe the activity in 1-3 sentences. *
Is this an Academic Service Learning (ASL) program? *

ASL is a curricular-based experiential learning that provides benefits to both the learner and the community partner through jointly-designed community-based activities that focus on specific learning objectives while also addressing a community-identified need.

Main source of funding (Please select all that apply) *












Scope of funding (excluding workload time – ordinary teaching beyond normal) (Please select one) *







Date of commencement
Is this activity completed? *

       Does it have an evaluation report? , please email to tice@westernsydney.edu.au

       Please indicate when it is planned to be completed.       
Please select all completed outcomes of the activity
Products Evidence based benefits











If you have any web links (e.g., reports, publications, video materials) on this activity, please enter their URLs in the text box below and select 'Add Link'.
Please describe the most significant outcomes of this activity for the partner and for Western Sydney University (1-3 sentences) *
Partner organisations involved in this activity
Organisation *
Website http://
Partner type *






Title of contact person
Contact name *
Position
Preferred email
Phone (Country Code) + Area Code + Phone Number *
( ) + +
Partner not to be contacted without the team leader's prior consent

Organisation *
Website http://
Partner type *






Title of contact person
Contact name *
Position
Preferred email
Phone (Country Code) + Area Code + Phone Number*
( ) + +
Partner not to be contacted without the team leader's prior consent
Comments/Reflection
What are your future plans for this activity? *
What lessons have been learnt from this activity that could be of benefit to others?
Best aspect *
Needs improvement *
Printed: 18/10/2017 11:44:33 PM