Key Center for Service-Learning
HU # 205, 251-6400
Appointment date__________________________
Time______________
Name________________________________________ Major___________________
Local Mailing Address_____________________________________________________
Phone_____________ E-mail__________________________________________
Please Circle One: Freshman Sophomore Junior Senior
Academic Interests: _______________________________________________________
Personal Interests: ________________________________________________________
Please circle any service opportunities in which you might be interested:
| People Served | Areas of Service |
| Preschool children | Promoting health & wellness |
| Elementary school age | Political issues |
| Middle school age | Women's issues |
| High school students | Social issues |
| Adults | Animals |
| The elderly | Foreign Language |
| Homeless people | The environment |
| Disadvantaged people | Tutoring & mentoring |
| People with disabilities | Sports & recreation |
| The arts | |
| Other______________________________ |
If you’re fulfilling a service- learning requirement for a class, please give me the name of the class
__________________________, the teacher’s name ______________________
and the number of hours of service-learning required __________.
Comments or questions_____________________________________________________
________________________________________________________________________