ࡱ> 130 bjbjSS .1122222FFFFZFnnnnnIII7999999$b #p]2II]22nnr 2n2n77:,nEI?"? #0IR#B##2tI>,$III]]-III#IIIIIIIII : MITCHELL COLLEGE General Education Requirement Form Social Responsibility CLUB OR CAMPUS Activity Note to the Student: The General Education Requirement to demonstrate SOCIAL RESPONSIBILITY as a student at Ǻ may be met by being an active member of a college sponsored club (one semester for an Associates degree; two semesters for a Bachelors degree), participating in college sponsored activities (10 hours for an Associates degree; 20 hours for a Bachelors degree), or by successfully completing a course with a Service Learning component (C- or better for the service learning component of the course). A C- or better for the service learning component of the course, without a passing grade in the course, can count as 10 hours of participation in a college sponsored activity. To receive credit for meeting this requirement by participating in a college sponsored club or activities: 1.) Fill out this form and obtain the signature of your club/activity advisor. 2.) Take the signed form to your academic advisor and obtain his/her signature. 3.) Take the completed form to the Registrars office. Student: _____________________________________________________________________________ Semester: ____________________________________________ Date: _________________________ Student Number: ________________________________ Campus Mail Box: ____________________ Anticipated Graduation Date: ______________________ Anticipated Degree: ___________________ Contact Information: ____________________ (Phone number or e-mail address that is used) This student has successfully completed _____________ SEMESTERS as an active member of a college sponsored club. This student has completed ________________ HOURS of participation in a community service activity. 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