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Do you volunteer? Please take a few moments to tell us what you do! Use this form to report your personal service hours, those you do individually, not as part of a group. Please DO NOT report Into the Streets as this information is automatically tracked.

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* 1. First and last name:

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* 2. Are you a

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* 3. Please tell us about your volunteer work and/or community service experiences. Examples could include: serving a meal at the Rescue Mission, volunteering at the Maria House, volunteering at the Red Cross, acting as a mentor/coach for Junior Achievement, etc.

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* 4. Location/site/agency (examples could include: Boys & Girls Club, Presentation Lantern Center, Camp Albrecht Acres, Multicultural Family Center, Swiss Valley Nature Center):

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* 5. During the academic year (Aug-May) how often do you participate?

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* 6. Total number of service hours completed during the academic year:
For example: 3 hours weekly x 12 weeks = 36 total hours

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* 7. Choose an issue area for the service completed.

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* 8. Please give a brief description of the service activity:

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* 9. Students only: How is the service an expression of one of Clarke’s core values of freedom, education, charity and justice?

Thank you for taking the time to fill out this survey! Please direct questions to Radie Roberts, Assistant Director of Campus Ministry, at radie.roberts@clarke.edu.

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