Community Service Form

Please fill out and submit the following community service form.

Date * +

Student Information

First Name *

Last Name *

Year *

Email Address *

Phone Number *

Organization Information

Name of Non-Profit 501c 3 Service Organization (UPPERCLASSMEN - This new rule only goes into effect, beginning September 5, 2018. Any hours submitted for last years service that do not meet this criteria will still be accepted for academic year 2017-2018). * 🛈

Organization Address *

Organization Mission *

Supervisor Information

Supervisor Name *

Email Address *

Phone Number *

Date Service was Completed * +

Hours of Community Service Performed *

In the space below, please provide In 2-3 paragraphs discussing the nature of the work performed while participating in community service. The following questions are suggestions of what to reflect on discussing your experience. You may answer all of the questions and include others you feel are relevant. Why did you participate with this organization? What did you learn about yourself while engaging in community service at this site? What were some moments of success? What were some challenges? What impact did you have on the community by participating? How can you incorporate your community service experience within your work as a Northeastern University student and beyond?

Description of Community Service *

Please attach a picture of your community service experience (optional)