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Tell Us Your Service Story

Fill out the form below to tell us about your service learning activities. Be sure to fill in all the blanks. Also, we would love to see pictures of your project! Please mail your pictures (and anything else you want us to know about your project) to the state 4-H office or e-mail them to agallimore@utk.edu.

For more information on how to answer some of the questions below, click on "more details."

Download a hard copy of this form by clicking here.
4-H GROUP
COUNTY
SERVICE PROJECT
DATE
LOCATION

 

PARTICIPANTS: youth adults

 

Hours (total # volunteers x # of hours)
Number of people benefitting from service
Estimated monetary value of service (more details)
Duration of the project (start and end date of service)  

 

Briefly describe the service. (more details)
How did participants reflect on the service (e.g., discussion, drawing, writing)? (more details)
How many participants learned from the service? (more details)
What did they learn?
How many will use skills/knowledge gained through the service? (more details)
How will they use it?

 

Discuss the project with the beneficiaries of the service. How do they rate the project? (select one)

not effective

somewhat effective

effective

very effective

highly effective

(more details)

In which of these service priority areas does the project fit? (select one)

environment

health

public safety

education

other human needs

other

 

Additional comments?

 

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