Form 1 Honor Roll Application

Application for the President's Higher Education Community Service Honor Roll

Honor_Roll_2010_Application_Final_9.8.10

Application for the President's Higher Education Community Service Honor Roll

OMB: 3045-0120

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3045-0120 can be found here:

2013-09-25 - Revision of a currently approved collection

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The President’s Higher Education Community Service

Honor Roll Application

Program Purpose: The President’s Higher Education Community Service Honor Roll recognizes higher education institutions that reflect the values of exemplary community service and achieve meaningful outcomes in their communities. The Honor Roll is part of the Corporation for National and Community Service’s strategic commitment to engage millions of college students in service and celebrate the critical role of higher education in strengthening communities. Presidential Awards are made for General Community Service and for service in the Special Focus area identified in this year’s Application Guidance.

Uses of information: Information provided in the “exemplary project” descriptions may be published in connection with the Honor Roll on the Corporation for National and Community Service (CNCS) website. Information provided by this collection will be held solely by CNCS staff.

Registration Information

Account Information Username:_________________________________

Password:_________________________________

Email Address: _____________________________

Name of Person Contact Person First______________ Last: __________________

Department/ Office: _________________________

Email Address: _____________________________

APPLICANT INFORMATION

Institution of Higher Education: ___________________________________________________

(Official institutional name, as it will appear on the Honor Roll)

Name of chief executive officer: First: __________________ Last: __________________

Title (President, Chancellor, other): ____________________

Mailing Address: Street Line 1: ______________________________

Street Line 2: ______________________________

City: _____________________________ State: __

ZIP: ______

Phone: _______________ Fax: ________________

Email address: _____________________________

Campus Service Coordinator: First: ______________Last: __________________

Department/ Office: _________________________

Email Address: _____________________________

Name of Person Contact Person First______________ Last: __________________

Department/ Office: _________________________

Email Address: _____________________________

Official Department Contact Information: Street Line 1: ______________________________

Street Line 2: ______________________________

City: ________________________ State: ___

ZIP: ______

Phone: ________________Fax: _______________

Email address: _____________________________

Institution’s 6-digit IPEDS code _______ and 8-digit OPEID number ____________

Both are listed on COOL, at http://nces.ed.gov/ipeds/cool)

Total student enrollment (graduate and undergraduate, full and part-time): _____________

Institutional type (Check one):

Two-year public: ______ Two-year private: ______

Four-year public: ______ Four-year private: ______

Graduate students only, public ______ Graduate students only, private ______

Other (please describe) _______________________________________________

Minority-serving institution (Check as appropriate):

Historically Black College or University: _______

Hispanic-Serving Institution: _______

Tribally Controlled Institution: _______

Have you ever been a member of the Honor Roll?

Yes ________ No ________ Don’t know/ data not available ________

If yes, have you ever emphasized in your marketing materials (website, brochures, etc) membership on the Honor Roll?

Yes ________ No ________ Don’t know/ data not available ________

How did your institution learn about the Honor Roll program? (Indicate all that apply):

Media advertisement _______

Media news story _______

CEO’s letter to higher education chief executives _______

Outreach by CNCS or its programs _______

Outreach by Campus Compact _______

Outreach by another higher education organization _______

ACE Annual Meeting _______

National Conference on Volunteering and Service _______

Other _______

Definitions

Community service means: activities designed to improve the quality of life of off-campus community residents, particularly low-income individuals. Community service activities may include but are not limited to: academic service-learning , co-curricular service-learning (not part of an academic course, but utilizing service-learning elements) and other co-curricular student volunteer activities, as well as Work-Study community service and paid community service internships. Community service includes both direct service to citizens (e.g., serving food to the needy) and indirect service (e.g., assessing community nutrition needs or managing a food bank).

Academic service-learning means: service that is integrated with academic course content. It may involve direct or indirect service, and may include academic research.

CNCS programs include: AmeriCorps*VISTA, AmeriCorps*State and National, AmeriCorps*NCCC, Learn and Serve America, and Senior Corps.

Academic term means: quarter, semester or trimester.

****All estimates requested in this application are for the

12-month period ending June 30 of the Honor Roll year****

Institutional Commitment to Service Statement

Describe your institution’s commitment to service; provide the background and context of this commitment and brief, varied examples of how it is demonstrated on campus and in the institutional culture. This is your opportunity to explain the culture of service that exists at the institution and the impact that this culture has on the community.

This statement MUST include:

Detailed discussion of the institutional commitment to service, including:
- Explanation of the commitment of institutional resources to support service
- Brief examples of this institutional culture of service as it is integrated into campus activities;
Explanation of how that institutional commitment is implemented in the campus culture, academic programming and extracurricular activities;
Discussion of the impact and effect of this commitment to service in the community; and
Description of the conditions in the community that drove your institution to engage in service.

Max: 4000 characters

______________________________________________________________________________

General Community Service Section

The applicant must complete and submit all three project descriptions.

General Community Service: Exemplary Project Description 1

Project 1 Title: ________________________________________________________________

In this section, select one (1) service project that best exemplifies the “Institutional Commitment to Service” Statement.” This section provides the opportunity to explain, in detail, the service project, the connection of the project to the larger institutional commitment to service, and the impact of this service in the community.

The project selected for this section should be the one that most clearly aligns with the Institutional Commitment to Service Statement. This project should demonstrate the clearest connection to the institutional support for and commitment to service, and the strongest impact in the community.

Provide details pertaining to each of the three evaluation categories: Project Scope, Evidence of Project Effectiveness and Impact on Community. (See Application Guidance for definitions.)

This project description MUST include:

Explanation of the project and indication of the specific service provided, including:
- Who from your institution participates in the service (faculty, teachers, students, etc.);
- Who benefits from the service;
- Detailed evidence, including quantification, and description of the project’s benefits to the population served; and
Clear connection to the Institutional Commitment to Service Statement.

A strong project description SHOULD also include:

Program practices or institutional support elements that were found particularly helpful or effective;
Indication of whether student participation was during regular academic sessions or during summer or other breaks (indicate frequency of service);
Collaborations with community agencies, including K-12 schools; and
Whether the project was supported by Federal Work-Study, CNCS programs, or other government programs.

Max. 2000 characters

______________________________________________________________________________

Project Scope:

Number of Participating Students
Number of Student Hours Served
Number of Participating Faculty/Staff
Number of Faculty/Staff Hours Served
Estimated Number of Individuals Served

Evidence of Project Effectiveness: Quantity

Economic Opportunity
- Houses built
- Meals served
- Hours of job training and support provided
- Other

Education
- Students tutored/mentored
- Students assisted in undertaking service-learning
- Books read
- Other

Environment
- Community gardens built
- Streams monitored/remediated
- Bags of garbage collected
- Cans and bottles recycled
- Other

Health
- Number of people provided with health screenings
- Nutrition/healthy living lessons taught
- Other

Veterans and Deployed Personnel
- Veterans assisted with reintegration into the community
- Military families assisted
- Other

Other

General Community Service: Brief Project Description 2

Project 2 Title: ________________________________________________________________

In this section, select one (1) service project that exemplifies your institutional commitment to service. This section provides the opportunity to briefly describe another facet of your institution’s commitment to service, through the variety of projects in which the institution is engaged.

Provide details pertaining to each of the three evaluation categories: Project Scope, Evidence of Project Effectiveness and Impact on Community (see Application Guidance for definitions).

This project description MUST include:

Explanation of the project and indication of the specific service provided, including:
- Who from your institution participates in the service (faculty, teachers, students, etc.);
- Who benefits from the service;
- Detailed evidence, including quantification, and description of the project’s benefits to the population served; and
Clear connection to the Institutional Commitment to Service Statement.

A strong project description SHOULD also include:

Program practices or institutional support elements that were found particularly helpful or effective;
Indication of whether student participation was during regular academic sessions or during summer or other breaks (indicate frequency of service);
Collaborations with community agencies, including K-12 schools; and
Whether the project was supported by Federal Work-Study, CNCS programs, or other Government programs.

Max: 1500 characters

______________________________________________________________________________

Project Scope:

Number of Participating Students
Number of Student Hours Served
Number of Participating Faculty/Staff
Number of Faculty/Staff Hours Served
Estimated Number of Individuals Served

Evidence of Project Effectiveness: Quantity

Economic Opportunity
- Houses built
- Meals served
- Hours of job training and support provided
- Other

Education
- Students tutored/mentored
- Students assisted in undertaking service-learning
- Books read
- Other

Environment
- Community gardens built
- Streams monitored/remediated
- Bags of garbage collected
- Cans and bottles recycled
- Other

Health
- Number of people provided with health screenings
- Nutrition/healthy living lessons taught
- Other

Veterans and Deployed Personnel
- Veterans assisted with reintegration into community
- Military families assisted
- Other

Other

General Community Service: Brief Project Description 3

Project 3 Title: ________________________________________________________________

Provide details pertaining to each of the three evaluation categories: Project Scope, Evidence of Project Effectiveness and Impact on Community. (See Application Guidance for definitions.)

This project description MUST include:

Explanation of the project and indication of the specific service provided, including:
- Who from your institution participates in the service (faculty, teachers, students, etc.);
- Who benefits from the service;
- Detailed evidence, including quantification, and description of the project’s benefits to the population served; and
Clear connection to the Institutional Commitment to Service Statement.

A strong project description SHOULD also include:

Program practices or institutional support elements that were found particularly helpful or effective;
Indication of whether student participation was during regular academic sessions or during summer or other breaks (indicate frequency of service);
Collaborations with community agencies, including K-12 schools; and
Whether the project was supported by Federal Work-Study, CNCS programs, or other government programs.

Max: 1500 characters

______________________________________________________________________________

Project Scope:

Number of Participating Students
Number of Student Hours Served
Number of Participating Faculty/Staff
Number of Faculty/Staff Hours Served
Estimated Number of Individuals Served

Evidence of Project Effectiveness: Quantity

Economic Opportunity
- Houses built
- Meals served
- Hours of job training and support provided
- Other

Education
- Students tutored/mentored
- Students assisted in undertaking service-learning
- Books read
- Other

Environment
- Community gardens built
- Streams monitored/remediated
- Bags of garbage collected
- Cans and bottles recycled
- Other

Health
- Number of people provided with health screenings
- Nutrition/healthy living lessons taught
- Other

Veterans and Deployed Personnel
- Veterans assisted with reintegration into community
- Military families assisted
- Other

Other

General Community Service: Student Participation in Service

Estimate:

The number of students who engaged in academic service-learning.
The number of students who engaged in forms of community service not including the students counted in determining a) (unduplicated count).
The total number of students who engaged in community service of any kind (sum of a and b).
The number of students who engaged in at least 20 hours of any kind of community service per academic term.
The number of students whose service was supported by one or more CNCS programs.
The total number of all community service hours engaged in by the institution’s students.

Special Focus Area Section

If applying in the Special Focus Area, the applicant must complete and submit all three project descriptions.

Special Focus Area: Exemplary Project Description 1

Project 1 Title: ________________________________________________________________

In this section, select one (1) service project in the Special Focus Area that best exemplifies the “Institutional Commitment to Service” Statement. This section provides the opportunity to explain, in detail, the service project, the connection of the project to the larger institutional commitment to service, and the impact of this service in the targeted community.

Provide details pertaining to each of the three evaluation categories: Project Scope, Evidence of Project Effectiveness and Impact on Community. (See Application Guidance for definitions.)

This project description MUST include:

Explanation of the project and indication of the specific service provided, including:
- Who from your institution participates in the service (faculty, teachers, students, etc.);
- Who benefits from the service;
- Detailed evidence, including quantification, and description of the project’s benefits to the population served; and
Clear connection to the Institutional Commitment to Service Statement.

A strong project description SHOULD also include:

Program practices or institutional support elements that were found particularly helpful or effective;
Indication of whether student participation was during regular academic sessions or during summer or other breaks (indicate frequency of service);
Collaborations with community agencies, including K-12 schools; and
Whether the project was supported by Federal Work-Study, CNCS programs, or other government programs.

Max. 2000 characters

______________________________________________________________________________

Project Scope:

Number of Participating Students
Number of Student Hours Served
Number of Participating Faculty/Staff
Number of Faculty/Staff Hours Served
Estimated Number of Individuals Served

Evidence of Project Effectiveness: Quantity

Economic Opportunity
- Houses built
- Meals served
- Hours of job training and support provided
- Other

Education
- Students tutored/mentored
- Students assisted in undertaking service-learning
- Books read
- Other

Environment
- Community gardens built
- Streams monitored/remediated
- Bags of garbage collected
- Cans and bottles recycled
- Other

Health
- Number of people provided with health screenings
- Nutrition/healthy living lessons taught
- Other

Veterans and Deployed Personnel
- Veterans assisted with reintegration into the community
- Military families assisted
- Other

Other

Special Focus Area: Brief Project Description 2

Project 2 Title: ________________________________________________________________

In this section, select one (1) service project that exemplifies this institutional commitment to service. This section provides the opportunity to briefly describe another facet of your institution’s commitment to service, through the variety of projects in which the institution is engaged.

Provide details pertaining to each of the three evaluation categories: Scope, Measurement of Project Effectiveness and Impact on Community. (See Application Guidance for definitions.)

This project description MUST include:

Explanation of the project and indication of the specific service provided, including:
- Who from your institution participates in the service (faculty, teachers, students, etc.);
- Who benefits from the service;
- Detailed evidence, including quantification, and description of the project’s benefits to the population served; and
Clear connection to the Institutional Commitment to Service Statement.

A strong project description SHOULD also include:

Program practices or institutional support elements that were found particularly helpful or effective;
Indication of whether student participation was during regular academic sessions or during summer or other breaks (indicate frequency of service);
Collaborations with community agencies, including K-12 schools; and
Whether the project was supported by Federal Work-Study, CNCS programs, or other Government programs.

Max: 1500 characters

______________________________________________________________________________

Project Scope:

Number of Participating Students
Number of Student Hours Served
Number of Participating Faculty/Staff
Number of Faculty/Staff Hours Served
Estimated Number of Individuals Served

Evidence of Project Effectiveness: Quantity

Economic Opportunity
- Houses built
- Meals served
- Hours of job training and support provided
- Other

Education
- Students tutored/mentored
- Students assisted in undertaking service-learning
- Books read
- Other

Environment
- Community gardens built
- Streams monitored/remediated
- Bags of garbage collected
- Cans and bottles recycled
- Other

Health
- Number of people provided with health screenings
- Nutrition/healthy living lessons taught
- Other

Veterans and Deployed Personnel
- Veterans assisted with reintegration into the community
- Military families assisted
- Other

Other

Special Focus Area: Brief Project Description 3

Project 3 Title: ________________________________________________________________

Project Description:

Provide details pertaining to each of the three evaluation categories: Project Scope, Evidence of Project Effectiveness and Impact on Community. (See Application Guidance for definitions.)

This project description MUST include:

Explanation of the project and indication of the specific service provided, including:
- Who from your institution participates in the service (faculty, teachers, students, etc.);
- Who benefits from the service;
- Detailed evidence, including quantification, and description of the project’s benefits to the population served; and
Clear connection to the Institutional Commitment to Service Statement.

A strong project description SHOULD also include:

Program practices or institutional support elements that were found particularly helpful or effective;
Indication of whether student participation was during regular academic sessions or during summer or other breaks (indicate frequency of service);
Collaborations with community agencies, including K-12 schools; and
Whether the project was supported by Federal Work-Study, CNCS programs, or other government programs.

Max: 1500 characters

______________________________________________________________________________

Project Scope:

Number of Participating Students
Number of Student Hours Served
Number of Participating Faculty/Staff
Number of Faculty/Staff Hours Served
Estimated Number of Individuals Served

Evidence of Project Effectiveness: Quantity

Economic Opportunity
- Houses built
- Meals served
- Hours of job training and support provided
- Other

Education
- Students tutored/mentored
- Students assisted in undertaking service-learning
- Books read
- Other

Environment
- Community gardens built
- Streams monitored/remediated
- Bags of garbage collected
- Cans and bottles recycled
- Other

Health
- Number of people provided with health screenings
- Nutrition/healthy living lessons taught
- Other

Veterans and Deployed Personnel
- Veterans assisted with reintegration into the community
- Military families assisted
- Other

Other

Special Focus Area: Student Service Participation

The number of students who engaged in academic service-learning in the Special Focus Area – as identified in the Application Guidance.
The number of students who engaged in forms of community service in the Special Focus Area, not including the students counted in determining a) (unduplicated count).
The total number of students who engaged in community service of any kind related to the Special Focus Area (sum of a and b).
The number of students who engaged in at least 20 hours of community service per academic term in the Special Focus Area.
The number of students whose service in the Special Focus Area was supported by one or more CNCS programs.
The total number of service hours engaged in the Special Focus Area by the institution’s students.

Institutional Supports for Service

Is community service or service-learning explicitly cited in your institution’s mission statement or strategic plan?

Yes ________ No ________ Don’t know/ data not available ________

Does the institution make internal budgetary allocations to support service?

Yes ________ No ________ Don’t know/ data not available ________

Does the applicant institution have at least one full-time staff member responsible for coordinating student community service or service-learning activities?

Yes ________ No ________ Don’t know/ data not available ________

If yes, how many? ________

Does the applicant institution provide scholarships or other financial rewards to students for community service, such as “matching” the Segal AmeriCorps Education Award?

Yes ________ No ________ Don’t know/ data not available ________

Does the applicant institution offer academic courses that integrate community service with academic content, i.e., academic service-learning courses, as defined above?

Yes ________ No ________ Don’t know/ data not available ________

If yes, approximately how many? __________

Does the applicant institution require academic service-learning courses as part of the core curriculum of at least one major or disciplinary area?

Yes ________ No ________ Don’t know/ data not available ________

Does the applicant institution reward the use of academic service-learning through faculty promotion and tenure decisions, or by providing awards or professional development opportunities?

Yes ________ No ________ Don’t know/ data not available ________

Is the applicant institution recognized under one of the Carnegie Foundation’s Community Engagement classifications? (Check as appropriate):

Curricular Engagement _______

Outreach and Partnerships _______

Curricular Engagement and Outreach and Partnerships _______

Government Supports for Service

Does the applicant institution utilize AmeriCorps, including VISTA, members in recruiting student volunteers or coordinating student service projects?

Yes ________ No ________ Don’t know/ data not available ________

Does the applicant institution have an ongoing grantee, sub-grantee or other supportive relationship with any of the following CNCS programs?

Learn and Serve America ______

AmeriCorps*State and National ______

AmeriCorps*VISTA ______

AmeriCorps*NCCC ______

Senior Corps ______

Please identify any ongoing relationship the applicant institution has with other Federal, State, or local government agencies in support of student community service activities: ________________________________________________________________

________________________________________________________________

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS APPLICATION.

WE APPRECIATE ALL THE WORK THAT YOU DO!

The Paperwork Reduction Act Statement

Public Burden Statement: The Paperwork Reduction Act of 1995 requires the Corporation to inform all potential persons who are to respond to this collection of information that such persons are not required to respond unless it displays a currently valid OMD control number (See 5 CFR 1320.5(b)(2)(i).

Time Burden: The time required to compete collection of information is estimated to average 1 hour per applicant.

Use of Information: The information collected constitutes an application to the Corporation for recognition. The Corporation evaluates the application and makes decisions through the review and selection process.

Effects of Non-Disclosure: Providing this information is voluntary; however, failure to provide the information is would not allow the Corporation to assess the applicant’s request for recognition. In this case, it will not be possible to consider the applicant for inclusion on the President’s Higher Education Community Service Honor Roll.

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File Type	application/msword
File Title	The 2009 President’s Higher Education Community Service
Author	Anne Wellde
Last Modified By	Amy B.
File Modified	2010-09-08
File Created	2010-09-08