7-digit SU ID#
Emergency Contact Name
Emergency Contact Phone
If selected Other, please specify
Racial/Ethnic Background (check all that apply)
If selected Other, please specify
Please select your SU affiliation
If Undergraduate Student, Major
Anticipated Year of Graduation
Are you an International Student?
Are you currently in a Service Learning class?
If yes, what is the last name of your Service Learning Professor:
Have you participated in other CSCE/SUYI programs? (check all that apply)
Please select the TOTAL number of quarters participated from your selections above. (If you have not participated in above programs, select 0):
carefully. Checking the "I agree" box indicates that you
agree to the following:
I understand the service expectations
presented by the Seattle University's Center for Service and Community
Engagement (CSCE) and agree to the following:
Attend a service orientation session prior to being placed in a
school and attend service reflection sessions or related workshops and
trainings during your volunteer/service learning commitment. Dates and
times are announced via email.
Comply with all policies of the placement site.
Provide a minimum of two hours per week for at least one
academic quarter at your placement site.
Contact the CSCE staff 296-2569 and report any problems or
difficulties that may arise during your service experience
CHECK: Seattle University
obtains or asks others on its behalf to obtain, consumer reports and/or
investigative consumer reports, including Background Checks for criminal
convictions and civil findings related to violence, abuse, and/or neglect
against minors or vulnerable adults, from a consumer reporting agency regarding
applicants who will be working with minors. These reports assist us in
evaluating individuals for volunteer and service learner placement with Seattle
University's Center for Service and
Community Engagement partner schools and organizations.
I understand that this service placement requires me to complete
an online Background Check. (Background checks
are only required once every academic year).
I understand that I will receive an email with an online
link and instructions for applying for my Background Check from TalentWise.
I understand that my service placement is considered
"pending" until the results of my online Background check have been
made available to the Center for Service and Community Engagement.
If I fail to complete the Background Check application within 48
hours of receiving email instructions, I understand that my registration with
this service site may be dropped.
I understand that I have an ongoing obligation to report any
future criminal convictions or civil adjudications to the Center for Service
and Community Engagement while I am participating in service.
I understand that this Background Check does not take the place
of any application processes that my service site requires.
I understand and agree that Seattle University's Center for
Service and Community Engagement will receive the results of the background
check and can provide a copy of the results to the service site, if the site
requests a copy. Finally, I understand and agree that the Center for
Service and Community Engagement has the sole discretion to determine my
suitability for participation in any aspect of the program, including my
suitability to serve, with or without regard to the results of my background
RISK RELEASE: I understand that in connection with my
participation in a Center for Service and Community Engagement and Seattle
University Youth Initiative sponsored programs. and/or my service, if I suffer
any injury (including death), illness, loss, or damage, I agree not to sue and
will release and forever discharge Seattle University and its governing board,
officers, faculty, employees, and students from any and all claims, demands,
causes of action, costs, or expenses that can or may arise from my participation
in Center for Service and Community Engagement and/or Seattle University Youth
Initiative sponsored programs and partner organizations. This release and
covenant not to sue is binding on my family, my heirs, and anyone else who
claims an interest through me or from me.
I certify that
the information given in the Service Application is true and complete to the
best of my knowledge. I agree to inform the CSCE staff promptly if any of
the information I provided changes during the time I participate in Seattle
University 's Center for Service and Community Engagement activities.
Checking the "I
agree" box indicates that you agree to the previous