Berg Service Challenge Commitment Form

Name: *

Email Address:

Name of Service Organization :

This should be the name of the service-site you will be working at or the name of the agency that you are serving for.

I am making the commitment to serve 10 hours Spring 2012 semester and I will contact the organization to work out the details.

Please include any commentary about your service experiences here:

I grant permission for my name to be listed on the Berg Service Challenge Web Page for Spring 2012.

I do NOT grant permission for my name to be listed on the Berg Service Challenge Web Page for Spring 2012.

Word verification: * Type the characters you see in this picture.

Type the characters you see in the picture above; if you can't read them, submit the form and a new image will be generated. Not case sensitive.

Main menu