* 1. Student ID Number

* 2. Last Name

* 3. First Name

* 4. Email

* 5. Phone Number (Where you can actually be reached)

* 6. Your Instructor/s must approve your Service-Learning activities for credit in each specific course. The connection of service with academics is key. If you have secured approval, please enter your course information here.

* 7. Are you doing Service-Learning for more than one instructor?

8. If you are doing Service-Learning for more than one course, be sure that EACH instructor knows about ALL the other courses for which you’re “counting” your S-L activities. They may require additional assignments/hours. Enter additional courses here.

* 9. Student Information

* 10. Class Standing

11. Languages spoken FLUENTLY other than English

* 12. Have you done Service-Learning at Chaminade before?

* 13. Have you done Service-Learning at any other school?

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