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Are you reporting as an individual or on behalf of a student organization?	Individual Service Hours Student Organization Service Hours
If service was affiliated with a student organization on campus, please check the group you worked with:	If other specify:
Your Name:
Campus Address or Local Mailing Address:
Phone:
Email:
Where did you volunteer?	If other specify:
Was this a one-time service event or is the community service continuous over a span of time?	One-time service event Continuous service
Total Number of Volunteers:
Total Number of Service Hours: (Note:The total number of service hours should reflect the combined amount of hours for the entire group.)
Date(s) of service:
If you are reporting a charitable donation, please indicate the dollar amount:
Which organization received your donation?
Please describe your community service activity:
Documentation is required of all monetary donations. Please submit a copy of the receipt or a letter from the organization to the Office of Community Engagement.
I certify that the information contained on this document is, to the best of my knowledge, accurate and complete.