Community Partner Request Form
If you would like to be considered as a placement agency with the Civic Engagement Program at Bristol Community College please complete the form below.
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Agency Name:
I certify that we are a:
Agency Representative Name (person completing the form):
Agency Representative Title:
Agency Address:
Agency Contact Person & Job Title
Contact Person Phone:
Contact Person Email:
Agency Requirements for volunteers:
Select the keywords you would use to identify your agency:
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Brief Description of your Agency Function: (What does your organization do?)
General Responsibilities of Service-Learning Students (Describe anticipated service opportunities - Events, Projects, On-site needs, & duration of project or service)
Special Conditions/Requirements: (Time commitment, fees, background check, etc., if any)
Brief Description of any Orientation or Training Provided by the Agency (please also list if you are willing to do trainings with students on campus at BCC .)
Agency/School Hours of Operation: (Days and times of need for Service-Learning students)
If you have opportunities for family volunteering (parents to bring children) as well as evening or weekend opportunities, please describe below:
Is this a One-time or Annual request for Service-Learning Students?
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