Community Service/Leadership/Volunteering Experience

Please record your Community Service, Leadership or Volunteer Experience in the form below.

Student Name:


Start Date:

End Date:

Number of Hours (Planning, Participation, Research, Follow-up, etc.):

Name of Organization:

Contact Person with Organization:

Contact Phone Number:

One day event or recurring event?

Briefly describe the purpose of the experience/event, target audience, and why you chose to participate. (At least 50 words).

Describe your participation in the experience/event (including leadership role)?

How many people were involved? (Community/Audience)(Staff/Volunteers)

What was the impact of this experience/event? (On you, participants, community)

Would you recommend this event/experience to others? Why/Why Not?

What would you change about this experience/event? Why?

Overall, I would rate this event/experience (select one):