Student Life

Service Activity Form

If you do not want to fill out our on-line form...

If you are unable or do not wish to fill out our easy on-line form, you can download a PDF version here.

Please complete this form no later than ten days after completion of service. If you have any questions regarding activities that qualify as service, please consult a service or leadership staff person at 216-687-2048, or email service@csuohio.edu.

Personal Information

Today's Date:

First Name:

Last Name:

Home Phone:

Email Address:

Student ID:

Student Organization (if any):

(Note: Information needed to allocate points towards awards)

My CSU Relationship Student
Faculty
Staff
Alumnus
Visitor/Guest

If a student, what is your class level? First Year
Sophomore
Junior
Senior
Graduate
Law
Other

Service Activity Information

Service Agency
Service Agency Name:

(Note: Must be a non-profit organization)
Address:

City:

Event
Name:

Location of Service:

Start Date/Time of Service:

End Date/Time of Service:

Total Number of Hours Served:

Service Agency Contact
Agency Contact Name:

Agency Contact Phone:

Type of Service
Philanthropy
Service (volunteer activities without pay to benefit society, the community, individuals or environment)
Service Learning (required as part of a CSU academic course; unpaid)

Amount of Money Raised & Donated (if applicable):

Describe the service you performed today in detail, including types of activities, people involved, etc.
Describe the service you performed today in detail.

Service Activity Satisfaction:

Please rate your overall service experience with a grade of A, B, C, D, or F

I learned something new by serving today	A	B	C	D	F
My service impacted the community	A	B	C	D	F
Service is important to my life goals	A	B	C	D	F
Service is important to my professional goals	A	B	C	D	F
I enjoyed serving today	A	B	C	D	F
I would serve at this agency again	A	B	C	D	F

How did you learn about service opportunities: (check all that apply)
Flyers/Posters
Cauldron or Vindicator
Peers
Professors
Campus Mailbag Email

Please tell us about a challenging and/or rewarding experience you had during your service activity.
Please tell us about a challenging and/or rewarding experience you had during your service activity.

Student Life Home

Mailing Address
Cleveland State University
2121 Euclid Avenue, SC 319
Cleveland, OH 44115-2214

Campus Location
Student Center, Room 319
2121 Euclid Avenue
Phone: 216.687.2048
studentlife@csuohio.edu

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