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JH / HS Service Learning Form

Please complete the form below. Required fields marked with an asterisk *

Student Name*

Answer required for "Student Name"

Graduation Year*

Answer required for "Graduation Year"

Phone Number*

Answer required for "Phone Number"

Organization Contact Information

Supervisor Name*

Answer required for "Supervisor Name"

Organization Name*

Answer required for "Organization Name"

Email 1

Answer required for "Email 1"

Phone Number*

Number Required

Organization Address

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Service Learning Opportunity*

Answer required for "Service Learning Opportunity"

Service Learning Category*

Answer required for "Service Learning Category"

Community Service

Church Service

Hours*

Answer required for "Hours"

Date Worked*

Answer required for "Date Worked"

What did you observe during your service learning activity that made an impact on you?*

Answer required for "What did you observe during your service learning activity that made an impact on you?"

How did you feel about it? What did it make you think about? *

Answer required for "How did you feel about it? What did it make you think about? "

How was this activity similar or different from other educational activities? *

Answer required for "How was this activity similar or different from other educational activities? "

What did you learn? *

Answer required for "What did you learn? "

Based on what you have learned, in what areas do you need to grow and make extra effort? *

Answer required for "Based on what you have learned, in what areas do you need to grow and make extra effort? "

Signature*

Signature Required

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"