BEFORE PERFORMING OUTREACH SERVICE

  1. Fill out the OUTREACH ONLINE SERVICE FORM found below the line on this page

  2. Submit this form

  3. After submitting this form, you will receive SERVICE CONFIRMATION FORM;  save and print the SERVICE CONFIRMATION FORM;

  4. Follow instructions found on the SERVICE CONFIRMATION FORM for obtaining signatures and writing/submitting your reflection.

  5. Forms normally are due within 30 days; summer service forms are due by Sept. 14

**Submit a separate form for each occurrence of Outreach service.

OUTREACH ONLINE SERVICE FORM  

Last Name  
First Name  
Student I.D.  
Student e-mail  
Student Phone  

Select 1 of the following 3 options

Option1: Direct Service (choose from list)

Option 2: Community Service (choose from list)

Option 3: Other (enter name of service provider)
(service counted only after approval)

Organization Phone

  
Date when work will be performed (mm/dd/yyyy format)  
Projected number of hours for this service  

If this is a correction of the original form, check here: