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Student Volunteer Registration Form
1801 Fayetteville St. Durham NC 27707
919-530-6100

Student Volunteer Registration Form

NOTE: All NCCU students who fall under the graduation requirement must register for service by filling out this form. Students should select a service opportunity from the ACSLP Agency Book or the One-Time Events and enter the information at the bottom of the form. It is then the responsibility of each student to contact the community agency to work out details of performing their service. NCCU provides transportation Monday through Friday within three miles

Student Info:

First Name [Required] 

Last Name: [Required]

Local Phone Number:   [Required]  

Cellular Phone Number:

Local Mailing Address: [Required]

E-Mail Address: [Required]

NOTES:
***Your NCCU e-mail address is required.

***E-mail addresses collected through NCCU forms are used for statistical and security purposes only.

Academic Major: [Required] 

Classification: [Required]


Available Times:

Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:


Agency Info:
Choose from NCCU's ACSLP One-Time Events or from the ACSLP Agency Book
Note: These are PDF files requiring the popular, free Adobe Acrobat Reader.

Agency ID or OTE ID Number: [Required]

Agency Name: [Required]

Contact Name: [Required]

Agency Phone Number: [Required]

Agency Address: [Required]

Type of Service: [Required]

ACSLP Projects:

Service-Learning: Course No.     Instructor

Will need Transportation?