Post Secondary (College/University) Community Service Hours or Placement Inquiry Form

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Email *

First & Last Name: *

Email address: *

Telephone number: *

Date of Birth: *

Which college or university do you go to? *

What is the name of your course? *

What is your program contact's name, telephone number and/or email address? *

Which location would you like to do your CSL hours/placement at? *

Burlington

Milton

Mississauga

Orangeville

How many hours are you required to complete for your CSL hours/placement? *

Why would you like to do your CSL hours/placement at Habitat for Humanity? *

Do you have any restrictions or special requirements that we should be made aware of? *

Have you ever been charged or convicted of a criminal offence, or convicted of a past offence for which a pardon has not been granted? *

If yes, you will be required to speak with our Manager of Volunteer Services regarding the charges, even if pending.

Yes

Other:

Send me a copy of my responses.

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