Co-Curricular Experience Approval Form for Co-Curricular Mentors

This form is designed for Co-Curricular Mentos (Faculty/Staff) who are administering an experiential learning opportunity to request for that opportunity to count towards the Honors in Co-Curricular Engagement Honors designation. This designation is open to all students at the University of Houston, regardless of affiliation with the Honors College.

The following programs do NOT need to be submitted for approval:
-CITE funded programs
-Learning Abroad/Away programs approved through the Office of Learning Abroad

Approved recurring programs are granted a three-year approval, at which point the program will be re-evaluated before being renewed to count for the designation.

Applications are reviewed on a rolling basis. Co-Curricular Mentors are expected to track student participants and submit those at the conclusion of the program each time the program is offered.

For questions, contact hcce@uh.edu

Name Name * First Last
Title *
UH ID *
Must be 7 digits. Currently Entered: 0 digits.
Email *
Phone Phone * - ### - ### ####
Department *
College *
Role in Program/Project *
Other Administrators (with email addresses)
Title of Co-Curricular Experience *
Description of Experience *
Maximum of 500 words allowed. Currently Entered: 0 words.
Is this co-curricular program restricted to students in your college or department? *

Is this co-curricular program restricted to students in your college or department? Yes No
How is this program experiential for students?
What will students do?
What will students gain from this experience? *
Maximum of 300 words allowed. Currently Entered: 0 words.
Please indicate how often students will meet as part of this experience. *

Please indicate how often students will meet as part of this experience. Weekly Bi-weekly Monthly 2-4 times a semester
How would you describe the extent of engagement (modest, moderate, or extensive)? Base your response on how many hours and weeks will students participate in this activity?

How would you describe the extent of engagement (modest, moderate, or extensive)? Base your response on how many hours and weeks will students participate in this activity? Modest Moderate Extensive
Please explain why you described the extent of engagement as you did in the previous question. *
Maximum of 75 words allowed. Currently Entered: 0 words.
Please describe the reflection exercise or assignment for this experience. *
Maximum of 350 words allowed. Currently Entered: 0 words.
All programs or activities that count towards the Honors in Co-Curricular Engagement designation must have a reflection exercise for students.
Please check the competencies that students will hone or master through this experience. *

Please check the competencies that students will hone or master through this experience. Problem Solving Effective Communication Teamwork Ethical Decision Making Social Responsibility Cultural Competency Leadership

You must select at least two competencies
Please check the competencies that students will hone or master through this experience *

Competencies: Problem Solving, Effective Communication, Teamwork, Ethical Decision Making, Social Responsibility, Cultural Competency, and Leadership

https://uh.edu/honors/Programs-Minors/co-curricular-programs/hcce/co-curricular-mentors/
When will students take advantage of this experience during their academic career? (check all that apply) *

When will students take advantage of this experience during their academic career? (check all that apply) Freshman Sophomore Junior Senior
Is this co-curricular experience affiliated with a course? *

Is this co-curricular experience affiliated with a course? Yes No
Affiliated Course *

Provide course number and title (eg. ENGL 1301 Fundamentals of Writing I)
Indicate which degree plans, if any, REQUIRE this course. *
Is this a recurring experience? *

Is this a recurring experience? Yes No
When will this co-curricular experience be offered? *

e.g. Summer 2022
How often is this experience offered? *

How often is this experience offered? Every Summer Every Fall Every Spring Every Fall and Spring On a Rolling Basis Other Other
Which category best fits this co-curricular experience? *

Which category best fits this co-curricular experience? Undergraduate Research and Creative Experiential Learning Activities Community, Civic, and Global Experiential Learning Activities Professional, Scholarship, and Leadership Experiential Learning Activities