COMMUNITY SERVICE PROPOSAL

Clubs, Departments, and Organizations

Please don't fill out this input box.

Club/Org/Dept:

Club Sponsor:

Student Contact:

Phone #:

Email:

Date:

Community Service Project

(Mark appropriate field with an “√” and then specify the particular organization/faculty member/etc. you will be affiliated with)

In affiliation with:

Christian Service Program

Campus Ministries

Student Organization

FacultyStaff

Others

Community Partner/Organization

Organization:

Physical Address:

Mailing Address:

Contact Name:

Title:

Phone #:

Email:

Project Description

Brief Project Description:

Date(s) of Service:

Estimated Total Amount of Hours:

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