Name

Department

Student ID

Activity No.

Activity

Instructor

Organization

Date / Time

Venue

Materials /

Presentation

• Video Clip（DVD / CD）

• Photos ／Digital Files　

• Related Information and Digital Attachments

• Webpage□Others _________________

Objective

Content of Service

(e.g.) What/Whom have I contributed, seen, heard, or contacted from this activity?

Learning Inspiration

(e.g.) What have I learned from this activity? What does it mean to me?What do I think of the service I provided?What problems did I encounter?

Reflection

(e.g.) Whom can I helpin the future? How will I apply what I have learned? How have I changed my point of view toward the world or society?

Discussion

《e.g.》What resources and assistance do I need in regard to the activity? How can I overcome the challenges and difficulties based on the concept of service learning?

Feedback (Instruction)

Signature：Date：