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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.

Student Information

Activity Information:

Enter your start and end times for each date:

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Total Service Hours:

How many US Veterans were served? (optional)

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

Please provide contact information for your site supervisor.

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