Student Forms

Students are required to complete the following four forms, which are designed to cover the activities of Humboldt students enrolled in Service Learning or Academic Internship courses with community partners for course credit. Students should consult with their faculty before filling out these forms. All four Student Risk Documents are turned in to your faculty supervising your Service Learning or Academic Internship experience for course credit.

Humboldt Student Learning Plan - UNDERGRADUATES (pdf)

Humboldt Student Learning Plan - GRADUATES (pdf)

Humboldt Participation Guidelines (pdf)

Humboldt Student Time Log (pdf)

Humboldt Release of Liability (pdf)

Faculty Forms 

Faculty are encouraged to begin the process by contacting the Center for Community Based Learning (CCBL) at least one semester prior to course offering. ALL off campus/non Humboldt program sites where students will be in service are required to have Learning Site Agreement paperwork in place BEFORE students begin service at the location. Currently - over 300 hundred sites already have these agreements in place through existing partnerships with Cal Poly Humboldt.  Please contact us for a current list of approved sites or check your college pagelet on the faculty portal.

Establishing a New Site:

To establish a new Learning Site for community partners who are not currently approved, please download and fill out the Faculty Request for New Learning Site form and email to Stacy Becker at

See below for examples of the Learning Site Agreement and Learning Site Self-Assessment that community agencies must complete and sign in order to become a learning site with Cal Poly Humboldt.

Example: Learning Site Agreement

Example: Learning Site Self-Assessment

Additional Information

Students enrolled in Academic Internship and/or Service Learning courses at the University may create products/deliverables/valuable intellectual property while fulfilling course requirements that may or may not be in conjunction with employment/award, and/or through the use of University resources. The Addendum to the Student Learning Plan for Service Learning & Academic Internship Courses Intellectual Property with For Profit & Non-Profit Organizations form can be used in circumstances in which a student from an Academic Internship or Service Learning Course creates a product or deliverable, and shares the intellectual property with a Learning Site/Community Partner.