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Knights with a Purpose Community Service-Learning Student Application Form

Student Information

Date

Student ID

Current Classifications

Name

Address

City

State

Zip Code

Email

Phone Number

Organizational Information

Name of Organization(s)

Address

City

State

Zip Code

Coordinator

Title

Phone Number

Fax

Email

Student's Start Date

Date

I understand and agree to the terms of this placement and will hold myself to the ethical and professional standards of Southern University at New Orleans and those of the partnering organization.

First Name

Last Name

For additional information contact the Student Development Center at (504) 286-5360 or the

Coordinator of Community Service-Learning and Resource Manager, Cheryl Legohn-Tubbs at

(504) 286-5365 - Ctubbs@suno.edu