Student Name: E-mail address: Group #:

PAF 101 PROSPECTIVE COMMUNITY SERVICE FORM

Fill out the following information for the site in which you plan to complete your 5 hour
requirement for PAF 101.

Do you plan on fulfilling your requirement by taking PAF 110 or any other course?
If yes, list the course:

Otherwise indicate provide information asked for below:
Agency or Activity: (List others if more than one)

Describe what you plan to do:

Address or Location of Activity:
Planned date(s) to work:
Planned time(s) to work:

***Students must email this form to TAs before class begins on Wednesday, February
12
th
2014. Failure to do so will result in a 5 point deduction on Module 3***