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Do you volunteer? Please take a few moments to tell us what your group does! Use this form to report your group's service hours. Please DO NOT report Into the Streets OR a Campus Ministry service trip, as this information is automatically tracked.

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* 1. First and last name:

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* 2. Provide number of participating students:

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* 3. Provide names of participating students:

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* 4. List number of participating Clarke faculty/staff:

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* 5. 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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* 6. Name of group/organization/team/class you volunteered with:
Examples: volleyball team, COSPT, etc.

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* 7. State the name of the agency served, such as Boys & Girls Club.

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* 8. Where was the community service event held?

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* 9. During the academic year (Aug-May) how often does the group participate?

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* 10. Total service hours:
For example: 4 volunteers x 2 hours each = 8 hours

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

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

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

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* 14. Athletic teams only: How is the service an expression of the NAIA core values?

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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