SERVICE LEARNING VOLUNTEER TIME SHEET

Please complete this form, print, and submit to record each of your Service Learning activities at CSU. IF YOU ARE SERVING AS AN INDIVIDUAL, PLEASE SEE JULIE JONGSMA FOR SITE APPROVAL BEFORE YOU BEGIN, AmeriCorps Vista/Service Learning Office, Brewer Center (843) 863-7839.

Question Title

Student Information

Student Name:

Student Organization (If Applicable):

Student ID #:

Cell Phone:

CSU E-mail address: (@csustudent.net):

CSU Major:

Expected Graduation Date (MM/YY):

Question Title

Activity Information:

Type of Service (Service Learning or Volunteer):

Service Site:

Event:

Question Title

Enter your start and end times for each date:

Start

Date

Time

AM/PM

End

Date

Time

AM/PM

Start

Date

Time

AM/PM

End

Date

Time

AM/PM

Start

Date

Time

AM/PM

End

Date

Time

AM/PM

Question Title

Enter your start and end times for each date:

Start

Date

Time

AM/PM

End

Date

Time

AM/PM

Start

Date

Time

AM/PM

End

Date

Time

AM/PM

Start

Date

Time

AM/PM

End

Date

Time

AM/PM

Question Title

Total Service Hours:

Question Title

How many US Veterans were served? (optional)

Question Title

How many baby boomers were served (49 - 67 years old)? (optional)

Question Title

Please provide contact information for your site supervisor.

Name:

Title:

Phone:

E-mail:

Supervisor Signature: