| Organization information |
|
*Organization/agency name:
|
|
|
*Address:
|
|
| *City: |
|
| *State: |
|
| *ZIP code: |
|
| *Community partner contact name: |
|
| *Community partner contact e-mail address (if you do not have an email address please enter "NONE"): |
|
|
*Organization/agency website (if you do not have a website, please enter "NONE"):
|
|
| *Mission statement or purpose of community organization: |
|
*Briefly summarize the history of your organization.
|
|
|
*Describe the population served by your organization.
|
|
*What community needs are met by the organization?
|
|
| *List the possible activities/tasks that students may engage in. |
|
