Student Government Organization Activity / Community Service Form

Organization Name:
Event Name:
Date of Event:
Event Location:
Event Time:
Activity Type:
Number of Members Present:
Community Service Event:
Community Members Served/Involved:
Faculty Advisor/Supervisor:
Attending Physician:
Brief Summary of Event Activities:

Print Officer's Name:
Office Held:
Date Submitted:
Students Participating: * (If a Community Service Event)

Students wishing to participate in the event must be in good academic standing and have all necessary documentation, i.e., up-to-date immunizations, completed to be eligible to participate.