Center for Leadership & Service at Kean University

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Major(s)/Minor(s):

Anticipated Graduation:

Please list any special accomodations:

Are you eligible for work-study? Yes No Don't Know

Referred by:

Website

Flyer

The Cougar's Byte

Student Worker

Faculty/Staff

Please list any leadership roles or club affiliations at Kean University:

Please list any volunteer, community service and/or service learning activities that you have participated in at Kean University:

Service Area of Interest

Please check up to 3 areas

Animals	Government/Public Policy
Education and Literacy	Hunger
Advocacy and Mentorship	Domestic Violence
Arts & Culutre	Health & Medicine
Environment/Sustainability	Senior Citizens
Housing & Homelessness	Other:
Children & Youth

F.E.R.P.A. Service Release Form

Pursuant to provisions of the Federal Family Privacy Act of 1974 (Public Law 93-380), I hereby grant permission for a professional staff member of the Center for Leadership and Service to verify that I meet the following criteria:

am a fully matriculated Kean University student;
am free of probation with restrictions in residence, University-wide disciplinary probation or higher level disciplinary sanctions (University-wide probation with restrictions, suspension, or dismissal).
Have at least a 2.0 cumulative GPA for community service and service learning placements.

Student Name: A value is required.

Check this box if you have fully read and understand the F.E.R.P.A. Service Release Statement

Note: If your form will not submit, please verfiy that all required fields have been completed filled and are in the correct format. Any field that is required and not completed, or completed in the incorrect format, will appear highlighted in red.

If you experience any problems completing this application, or have any questions, please contact the Center for Leadership and Service at 908-737-5170 or by emailing serve@kean.edu.