CFCC Service Learning Project Information

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Please complete each page of this form to initiate the student Service Learning agreement for the CURRENT SEMESTER. A signed Student Agreement and College/Agency Agreement page must be printed and turned in to your instructor prior to commencing your Service Learning experience.

Please direct any questions or concerns to: Kate Santhuff, Service Learning Coordinator, Office of Service Learning, CFCC North Campus, 4500 Blue Clay Rd., Office NB-151, Castle Hayne, NC 28429, 910-362-7594, ksanthuff@cfcc.edu

Student Information

This information is required and will be used only for verification and correspondence during the semester of service.

Student Name *

Please provide first and last name.

CFCC or Alternate Email *

e.g., kjsanthuff495@mail.cfcc.edu

Daytime Phone Number *

Please provide cell number if possible.

Are you 18? *

Students must meet minimum age requirements set by the agency for which they volunteer. Please check with the agency before signing agreements.

Yes, I am presently 18 or older.

No, but I will turn 18 during the course of this semester.

No, I will not be 18 until after this semester is over.

Required

Emergency Contact Full Name *

Please provide first and last name

Emergency Contact Phone Number *

Please provide best number to reach.

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