1.	Are you:*
	Student Faculty Staff

2.	Did you complete your Community Engagement/Service Activity as part of a CSUB Club/Organization?*
	Yes, I did the service with a CSUB club/organization. (Go to Question 3) No, I did the service on my own. (Go to Question 4)

3.	With what CSUB Club/Organization did you complete this Community Engagement/Service Activity? (Ex: Chemistry Club)

4.	On what date did you complete the Community Engagement/Service Activity?*
	mm/dd/yyyy

5.	What is the name of the organization where you completed the Community Engagement/Service Activity?*

6.	Please provide a brief description of the Community Engagement/Service Activity.

7.	Are you reporting for yourself only or for a CSUB Club/Organization?*
	Myself only (Complete Question 8 and Skip questions 9 & 10) CSUB Club/Organization (Skip Question 8 and Complete Questions 9 & 10)

8.	How many hours of service did YOU complete during this Community Engagement/Service Activity?

9.	How many individuals (students, faculty, staff) participated during this Community Engagement/Service Activity?

10.	Please estimate how many hours each individual (student, faculty, staff) served, on average, during this Community Engagement/Service Activity.

11.	Please enter your First and Last Name.*

12.	Please enter your CSUB student/faculty/staff ID number.*