Agency Service Site Registration Form

Agency Name:
Street Address:
City/Town:
State:
Zip:
Phone Number:
Agency website address:
Contact Person Name:
Contact Person's Position in the agency:
Email Address:
   

Agency’s mission:
(What community need(s) do you fulfill? We strongly encourage you to attach additional information such as brochures, pamphlets, etc.)
   

**Information given on these forms will be given to those volunteers interested in serving at your agency (or faculty members interested in setting up a Service-Learning opportunity with your agency) in order to help those individuals better determine the suitability of the volunteer opportunity to meet their needs and interests.    
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