1. For use by graduate and undergraduate students enrolled in major courses for the current semester.
2. Submit one copy of this form for each service experience (single or multi-day).
3. All service hours must be submitted by the LAST day of class.
4. Service hours DO NOT roll-over to the next semester.
5. The service hour requirement is 15 hours per semester. It is recommended that you submit any additional hours of service. All hours will be recorded in the DOE service database. These records will be helpful for your Experiential Transcript and Professional Portfolio [exit exam].
6. Save or print a copy of page 2 for your records.

**This form can be used to record single and multi-day service experiences. Please use the appropriate box to record multi-day hours.

* First Name:

* Last name:


* Program of Study:

* Current Semester: