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:________________________________________________


General Contact Details of Contact person as Organisation:

Title:  __                                                                   Name and Surname:__________________________

Mobile Number:________________________     Office Number:____________________________



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


Middle School




Arts & Culture


High School


Faith Based


Community/Economic Development


Social Services – Children & Youth


Youth – Recreational Programs


Women’s Rights




Youth – School-Based Programs


Arts & Culture


Animal Welfare







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






































 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