The Peach State Louis Stokes Alliance for Minority Participation UGA LSAMP Community Service Form Spring 2018 Name: ____________________________________________ UGA ID # (810/811 #): _____________________________ Date of Submission: _________________________________ Date of Service Type of Duties Performed # of Signature of For Tutors Only For Tutors Only Subject Names of Service/Activity Hours Representative Matter Students (Tutoring, Elderly, Clean-up, Tutored Children, ect.) Please submit this form to the UGA LSAMP Office, 210 Holmes/Hunter Academic Building by Thursday, May 3 at 5:00 p.m.
The Peach State Louis Stokes Alliance for Minority Participation UGA LSAMP Community Service Form Spring 2018 Name: ____________________________________________ UGA ID # (810/811 #): _____________________________ Date of Submission: _________________________________ Date of Service Type of Service/Activity (Tutoring, Elderly, Clean-up, Children, ect.) Duties Performed # of Hours Signature of Representative For Tutors Only Subject Matter For Tutors Only Names of Students Tutored Please submit this form to the UGA LSAMP Office, 210 Holmes/Hunter Academic Building by Thursday, May 3 at 5:00 p.m.