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Fall 2022 Springfield Bound Registration
Five College Community-Based Learning Committee
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Date: September 24th, 2022
Time: 10 AM - 3:30 PM
VIA ZOOM
Last name:
(Please use the name that you will use on your zoom profile when you attend the event)
*
Your answer
First Name:
(
Please use the name that you will use on your zoom profile when you attend the event)
*
Your answer
E-mail:
*
Your answer
Affiliation
*
Amherst College
Hampshire College
Holyoke Community College
Mount Holyoke College
Smith College
UMass Amherst
Westfield State University
Community Partner
High School
Other:
Department / Unit / Organization / Grade
*
Your answer
Accessibility
If you need any disability or accessibility accommodations, please specify:
Your answer
STUDENTS ONLY - Please complete the following:
Why are you attending Springfield Bound? Check all that apply:
Requirement for a course.
Requirement for my community placement.
A friend, classmate, peer, staff or faculty member suggested I attend.
Want to learn about the City of Springfield.
Want to learn about how to better engage with the City of Springfield.
Want to learn about volunteer opportunities in the City of Springfield.
Want to learn about internship opportunities in the City of Springfield.
Other:
If you are attending Springfield Bound for a course, please specify the course title, department/ number and instructor. (Example: Power and Privilege in Education, SOC 285, Sam Smith)
Your answer
Have you attended Springfield Bound before?
No, this is my first Springfield Bound.
Yes, I have attended Springfield Bound. (please specify how many times attended in the "other" section).
If yes, please specify how many times you have attended Springfield Bound
Your answer
Do you already have a community based learning/service learning internship, fellowship or volunteer placement in Springfield?
Yes
No
If yes, please specify type and organization (Example: Internship with "No One Leaves")
Your answer
Please specify your role with the organization. Check all that apply:
Tutor
Mentor
Teacher
Researcher
Research Assistant
Volunteer Coordinator
I do not have a role with any organizations in Springfield.
Other:
If you do not have a role with an organization in Springfield, what type of placement are you looking for? Check all that apply:
Elementary School
High School
Adult Education
After School Programs
Government
Social Service Organization
Environmental Organization
Public Health Organization
None. I am not looking for placement at this time.
Other:
How did you hear about Springfield Bound? Check all that apply:
Flyer
Emaiil
Social Media
Peer
Faculty
Amherst College Center for Community Engagement
Hampshire College Partnerships for Social Change
Mount Holyoke College Community Based Learning
Smith College Jandon Center for Community Engagement
UMass Civic Engagement & Service Learning
Other:
Thank you for your registration. We look forward to seeing you at Springfield Bound!
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