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Stanly STEM EARLY COLLEGE Service Learning Opportunity
Please provide complete & accurate information about your community service experience.
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Email
*
Your email
Student Last Name
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Your answer
Student First Name
*
Your answer
Student ID Number
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Your answer
Type of experience:
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volunteer
internship
job shadowing
Other:
Required
Service Description (What did you do? Be specific. Give examples.)
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Your answer
Business/Organization/Group Name
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Your answer
Business/Organization/Group Address, City, Zip
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Your answer
Supervisor Name & Title
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Your answer
Supervisor email
Your answer
Supervisor phone number
*
Your answer
Date(s) & Time(s) of Service
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Your answer
Total Number of Hours Earned
*
Your answer
A copy of your responses will be emailed to the address you provided.
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