Agency Information and Service Description

Agency and Contact Information

Name of your agency:

Contact name:

Address 1:

Address 2:

City, Zip:

Telephone:

Fax:

e-mail:

Agency Web site:

Hours of operation:

Is your agency accessible by public transportation? Yes No

Which categories best describe your agency’s area of service? (please check all that apply) AIDS/HIV+ Arts and Culture Children and Youth Education Elderly/Senior Care Environment Health Care Homelessness/Hunger Immigrants and Refugees Multiculturalism/Diversity Sexuality and Gay Rights Social Services Women's Issues Disabilities/Special Needs Other:

Which social groups do you serve? (please check all that apply) Adults Animals Children Elderly Families Gay/Lesbian Infants Minorities Parents Preschool Women Youth Other:

Please provide a brief description of your agency and mission:

Volunteer Opportunities

Position Title:

Qualifications and skills desired: (please check all that apply) Tutors/teaching assistants Writers Organizers Theater/Performers Web developers Marketing/Advertisers Video/Media skills Fundraisers ESL/Language Specialists Special events planners Other:

Required time commitment? Yes No

If Yes, please specify the duration and time students are needed. (please check all that apply): Ongoing (Semester) Ongoing (Academic Year) One-Time Group Projects Other: Times: No specific requirement 1-2 hrs/week 3-4 hrs/week >4 hrs/week Other:

Number of students/volunteers needed per semester:

Type of orientation provided:

Please provide a brief description of the responsibilities and related experience involved: