Community Service Form
Name:
Program:
Program Date:
Time In: Program Coordinator’s Name:
Program Coordinator’s Signature:
Time Out: Program Coordinator’s Name:
Program Coordinator’s Signature:
Description of Program and your responsibilities (To be completed by
student):
Upon the completion of your community service hours, please return this form with
all the necessary signatures to Michelle Spiegel in the Office of Residence Life,
located at the back of Hurst Hall.
If you have any questions, comments and/or concerns, please feel free to contact
me at MSpiegel@drew.edu or x3230.