This form is to be used by student organizations or other groups to record their combined community service hours.
Name of the Group/Student Organization
Main contact person for the group:
First Name:
Last Name:
Title:
Phone:
Email Address:
University ID Number:
Department/Major:
Location/Organization where community service was provided:
Address:
Street:
City:
State:
Zip:
Contact person at location who can verify this service was provided:
First Name:
Last Name:
Phone:
Email Address:
Type of Service:
Please select...
Academic/Tutoring
Enhancing the Neighborhood
The Environment
Fundraising Event
Helping Animals
Helping the Government
Helping the Hungry/Homeless
Helping Senior Citizens
Helping those with Special Needs
Performing Arts and Sports
Other
If you selected "other" above, please tell us what you did:
Last all members of the student organization who participated:
Number of combined hours volunteered:
Date/Dates this service was provided:
Short description of the project:
Thank you for volunteering your time and for reporting your hours.
Contact Information