Survey - Provost Scholars

Provost Scholars Program Verification of Student Service

Thank you for verifying the Prospective Scholar's student service activity as part of their application for the 2020-2021 academic year. For more information about the Provost Scholars Program, please visit www.case.edu/provostscholars. If you have any questions, please feel free to contact Kate Klonowski (Program Coordinator) at kak121@case.edu. This form must be returned no later than April 1, 2020.

Name of Prospective Scholar (First/Last) *

Name of Person Verifying Student Service (First/Last) *

Name of the Service Organization *

Please describe the nature and the time involved of the service: *

Please offer any additional comments or insights about the Prospective Scholar that would help us understand the range of their service work:

I attest that the information I have provided here is true to the best of my knowledge. *