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* 1. What is your name?

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

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

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* 4. Would you work with this organization again?

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* 5. How many hours did you work?

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

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

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