Last Name: 

First Name: 

Winthrop Email Address: 

Phone number:

Select if volunteer work was done individually   Individually SOAR Greek organization Faith-based organization Other club/organization Government/municipality ACAD Class Service Learning (not ACAD)

or, if not, the type of club/organization it was done with (select best answer)

Name of club/organization/agency if applicable:

Name of community group/non-profit that you

 did work for (i.e. Pilgrim's Inn, Humane Society, etc.): 

Type of project (select best answer) Administrative/Support work Advocacy/Awareness Raising beautification/renewal fundraising maintenance/construction Mentoring Tutoring work with people with disabilities work with elderly work with animals

How many times did you/your group volunteer

with this community group this semester?  (select best answer)  One-Time 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

Number of hours spent per visit on average (if it was a one-time 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5

project, put amount of time on this visit...round to nearest half hour)

Additional Comments

Would you recommend working with this non-profit/community group in the future? Yes No

Why or why not:

Thank you for your assistance!