Individual Informaiton Please provide the following information, the individual wh operformed the community service. You must have JavaScript enabled to use this form. First Name: * Last Name: * UC Merced Student ID: * UC Merced Email Address: * Phone Number: * Club/Organization Affiliation (if applicable) Please Provide details of the community service you performed, including hours donated, organization served and more. Number of Service Hours Donated: * Date of Service: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20242025202620272028 Describe the activity in which you participated: * Benfiting Agency, Cause, or Person: * Name of On-Site Contact: * Email Address of On-Site Contact: Phone Number of On-Site Contact: * Reflection: * Please write at least 5-10 sentences about your volenteer experience with this community service project. Explain how the project or the people affected you and what you learned about yourself and others. Confirmation and VerificationBy Submitting this form, I verify all of the information above is true and correct. Leave this field blank
