THE UNIVERSITY OF LOUISIANA AT MONROE
KITTY DEGREE SCHOOL OF NURSING
REPORT OF PROFESSIONAL/COMMUNITY SERVICE ACTIVITY
(Students are required to have four (4) hours of community service.
SEMESTER AND
YEAR
STUDENT
DATE
TIME
from
to
ROLL #
# OF HRS SERVED
EVENT
LOCATION
DESCRIPTION OF PROFESSIONAL SERVICES (OR COMMUNITY SERVICE FOR
NURSING STUDENTS IN COURSES BELOW NURS 3004) PROVIDED BY THE
STUDENT
SIGNATURES
STUDENT
1/25/16
EVENT REPRESENTATIVE