Types of Service--Outreach Main Page        Community Service Form    Direct Service Form    Reflection/Journal Forms 

 DIRECT SERVICE SUBMISSION FORM 2010-2011

DIRECT SERVICE INSTRUCTIONS

  1. Continue on this form ONLY if the service meets these all of these requirements:

    • those served are poor, disabled, marginalized or sick;
    • relationship with those served occurs in a sustained, ongoing way;
    • service includes conversation and spending time in companionship;

  2. Download the DIRECT SERVICE REFLECTION FORM  to be submitted later.

  3. Complete and submit the information in the box below (must submit a separate form for each DIFFERENT place of Outreach service)

  4. After submitting, you will  see a new screen containing  DIRECT SERVICE CONFIRMATION PAGE

  5. Save and print the confirmation page;  follow all instruction listed there.

  6. Forms are due within 30 days of giving service; forms for service completed during summer are due by September 20.

    7.

READ ALL INSTRUCTIONS ABOVE BEFORE SUBMITTING THIS FORM
(ALL INFORMATION IS REQUIRED)
1. STUDENT INFORMATION
 
Name     
Year of Graduation 
JC Patriot Email 
2. DIRECT SERVICE INFORMATION
 
 Name of organization
Organization Phone
Date of service (mm/dd/yyyy)
 e.g. 10/23/2009
3. SUBMIT THIS FORM--THEN SAVE & PRINT THE DIRECT SERVICE CONFIRMATION PAGE