Service Learning Agency Sign Up Form

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* 1. Organization name

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* 2. Contact name

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* 3. Street address

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* 4. Email

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* 5. Phone

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* 6. Fax

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* 7. Communities served

East Grand Forks

Thief River Falls

Grand Forks

Other (please specify)

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* 8. Description of agency

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* 9. Agency website:

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* 10. Service category(s)

Adult Care

Animals

Arts

Computer/Technology

Education

Environment

Faith-Based

Finance/Accounting

Health

Historical & Cultural Sites

Legal Services

Marketing/PR/Event Planning

Political Action/Social Justice

Social Services

Special Needs

Sports & Fitness

Youth

Other (please specify)

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* 11. Types and description of student positions

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* 12. Number of positions available/students needed:

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* 13. Days and times students may perform service:

Weekdays daytime

Weekdays evenings

Weekends daytime

Weekends evenings

Service Learning Agency Sign Up Form

Question Title

* 1. Organization name

Question Title

* 2. Contact name

Question Title

* 3. Street address

Question Title

* 4. Email

Question Title

* 5. Phone

Question Title

* 6. Fax

Question Title

* 7. Communities served

Question Title

* 8. Description of agency

Question Title

* 9. Agency website:

Question Title

* 10. Service category(s)

Question Title

* 11. Types and description of student positions

Question Title

* 12. Number of positions available/students needed:

Question Title

* 13. Days and times students may perform service:

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* 14. Special conditions or requirements:

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* 15. Additional information students might find useful: