Service Learning Request Form

Thank you for requesting WKCTC Service Learning students.  Please fill out the form below and click on Submit.  We would like for you to submit the form at least three (3) weeks prior to the scheduled event.  Requests are filled on a first come, first served basis.  Every effort will be made to fulfill your request pending student availability. All cancellations should be made five (5) days prior to the scheduled event by calling 270-534-3156 or 270-534-3118.  Note that an asterisk (*) denotes a required field.

*Today's Date  format mm/dd/yyyy

*Date of Event  format mm/dd/yyyy

*Time of Event  
*Location of Event    
*Choose a type of community event from the list. (Choose only one.)     
If you checked other, give the type of community event. 
Name of Student Requested
*Number of Hours Needed 

*Time Service Learning student is needed
*Name of Person in Charge 
*Phone (Home and/or Cell)  
* Email (NOTE:  You can list only one email address--Any other email addresses can be listed in the Comments section)
*Emergency Phone Number (s)
By submitting this request, I understand that I am responsible for overseeing the Service Learning students while they are assisting with this event.