Service Learning Hours
Mercy College of Ohio Faculty Service-Learning Hours Submission Form
Faculty Member First Name
Faculty Member Last Name
Course Name and Number
Date of Service
Did all students serve at the same site?
Yes
No
Service Site
Service Site/Location
Site Coordinator Name:
Site Coordinator Email Address
Site Coordinator Phone Number
Please list each student who participated in the service experience and the number of hours completed by each student.
Student Participation
Student First Name
Student Last Name
Hours Completed
Site Location
Site Coordinator Information
(Name, Phone, Email Address)
Verification
Have the service hours listed above been verified by the site coordinator?
Yes
No
If applicable, please provide any additional information regarding verfication:
Mercy College of Ohio, a Catholic institution with a focus on healthcare, educates and inspires students to lead and serve in the global community.