Request to Initiate Campus-Community Partnership
Many organizations find that working with college students allows them to expand the capacity of their organization or agency while allowing them to provide students with an opportunity to have positive learning experiences. Through service learning, students are able to examine the role of community organizations and contribute to them while also enhancing their understanding of course content.
Organization Name:________________________________________________
Type of Organization:________________________________________________
WEBSITE:_____________________________________________________
General Contact Details of Contact person as Organisation:
Title: __ Name and Surname:__________________________
Mobile Number:________________________ Office Number:____________________________
E-mail:__________________________________
Address:
Street Address:_______________________________________________
Suburb:__________________________________ City:_________________________
Province:______________________________ Code:_____________________
What is the Mission of the Organization?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
ICommunity Issues Addressed by the Organization (check all that apply):
Elementary School |
| For Profit |
| Animal Welfare |
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Middle School |
| Non-Profit |
| Arts & Culture |
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High School |
| Faith Based |
| Community/Economic Development |
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Social Services – Children & Youth |
| Youth – Recreational Programs |
| Women’s Rights |
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Technology |
| Youth – School-Based Programs |
| Arts & Culture |
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Animal Welfare |
| Environmental |
| Other: |
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Request to Initiate Campus-Community Partnership
What is the minimum number of students can you accommodate at our site in a service project per term?_________________________
Days and hours you will accept students for service (check all that apply)
| 12:00 – 13:00. | 13:00- 14:00 | 14:00 p.m. – 15:00 | 15:00 – 16:00 | 16:00 – 17:00 |
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Tuesday |
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Wednesday |
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Thursday |
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Friday |
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Saturday |
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Service Sites:
On- Site Supervisor name:______________________________
Phone:___________________________________ E-mail:_________________________
Briefly describe any ongoing needs or special projects with which students can assist agency staff
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Risk Management & Partnership-
Would the Organization be able and willing to complete a self-assessment of risks inherent to the students’ service environment associated with the organization and service sites (facility hazards, location concerns, client or personnel issues, etc.)?
Yes No
(2) In the event that additional, unforeseen risks become apparent, the Organization must agree to timely communicate all risk-related concerns to the University. Please indicate the Organization’s acknowledgement of this requirement:
Accept Decline