First Name:
Last Name:
Name of Project:
Email Address:
W#:
Phone:
Address Street: City: State: Zip Code:
Provide the following information about your Faculty/Staff mentor: Name: Department:
Provide the name(s) and email address(es) for additional student collaborators (if any):
Would you be willing to showcase your project at an assigned time during the event? Yes No
Does your project have any interactive capabilities? (video, dancing, oral readings, etc.) Yes No
Abstract (300 word limit) This is a description of your community-based learning project. It should include: a description of purpose and implementation of your project in the community; context for importance or relevance of the project to the community; and its outcomes for yourself personally, academically, and professionally.
Upon the successful completion of this form, you will be automatically directed to the Service Symposium homepage. You will be contacted regarding your acceptance status in 2 to 3 business days.
