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Faculty Request for Partnership
*Please, note that new partners are typically vetted in the summer*
Your Information & Agency Information
*
1.
Please enter your:
(Required.)
Name
Email address
Phone number/extension
2.
Name of agency
*
3.
Enter the following information for the agency contact:
(Required.)
Name
Title
Email address
Phone number
*
4.
Have you had any contact with this person?
(Required.)
Yes
No
*
5.
Which of the following applies to the agency?
(Required.)
501(c)3 non profit
public agency
private agency
*
6.
Does this agency have liability insurance that covers on-site volunteers?
(Required.)
Yes
No
I don't know
7.
Does the agency have any full-time, paid staff? If so, how many?
8.
Give a brief summary of the mission of the agency.