Student Release Form
The Center For Service Learning
7201 Rossville Boulevard
Baltimore, Maryland 21237
Social Science and Human Development
L Building--Room 313A
Be sure of the assigned site, location, phone number, supervisor,
and the date and time of your service prior to the service date.
Before you return the form indicating that you have completed your
assignment make sure that it is complete and includes signatures of
the site supervisor as well as your own.
Be aware that you will not receive credit for your work unless you
complete your service assignment.
Please understand that you have entered into a cooperative
obligation and that you agree to fulfill your responsibility to your
assigned service site.
Statement of Confidentiality
I understand that all activities in which I am involved as a service
learning participant are to be kept in the strictest of confidence. I
will not release or exchange any type of personal information concerning
clients of the agency I am to serve without written authorization from
the appropriate organization supervisors.
Please note: Students should carefully read, sign, date, and
return to the following address upon completion:
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