Faculty Request for Partnership
Please, note that new partners are typically vetted in the summer

Your Information & Agency Information

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* 1. Please enter your:

Name

Email address

Phone number/extension

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* 2. Name of agency

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* 3. Enter the following information for the agency contact:

Name

Title

Email address

Phone number

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* 4. Have you had any contact with this person?

Yes

No

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* 5. Which of the following applies to the agency?

501(c)3 non profit

public agency

private agency

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* 6. Does this agency have liability insurance that covers on-site volunteers?

Yes

No

I don't know

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* 7. Does the agency have any full-time, paid staff? If so, how many?

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* 8. Give a brief summary of the mission of the agency.