* 1. What is your name?

* 2. On what date did you perform your community service? (MM/DD/YY)

* 3. What was the name of the organization you worked with?

* 4. Would you work with this organization again?

* 5. How many hours did you work?

* 6. What was the nature of your community service work?

* 7. Did any students participate in this community service with you?