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PARTICIPANT AGREEMENT FORM
CAMPUS SERVICE COMMISSION
First Name
Last Name
Student ID #
Email Address
Phone Number
PO Box
Agency Name
Adult Basic Education
ARC Buddies
Churches United for the Homeless
Cobber Kids
Eventide - Adopt a Grandparent
Habitat ReStore
Madison Elementary Tutoring
MeritCare
New American Services
Nokomis Childcare
YWCA
Other
Semester of Service
Fall 2009
Spring 2010
Are you serving as part of a class?
Yes
No
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