Agency Information

Agency Name:

Agency Website:

Agency Street Address:

(Location at which student(s) will serve)

State:

City:

Zipcode:

Primary Student Supervisor Contact

Multiple individuals from your organization may have a supervisory role in guiding a student's service learning activities. Please provide contact information for the primary supervisor.

Primary Supervisor First Name

Phone Number

Primary Supervisor Last Name

Role at the Organization

If a student wants to work with your organization, how should they initiate the process?

Working with UC Students

Agency Mission Statement

Please share one or two sentences about your mission.

Which of these best describe your organization? (Check all that apply.)

Hospital

Community clinic

Education setting

Working with children

Working with people with disabilities

Working with the elderly

Working with veterans

Fitness

Faith-based work

Creative healing methods

Other...

How do you plan to utilize Medical Sciences student volunteers at your organization?

In addition to direct service with your organization, is there a project a student could complete to support your organization's mission?

What are some characteristics of successful student volunteers in these roles?

Details

What days and times do you need UC volunteers?

Please note that College of Allied Health students have a required class on Mondays or Wednesdays from 3:35-4:30pm and are not available at this time.

Please describe any necessary requirements for training, orientation, applications, background checks, or immunizations.

If there is a specific onboarding timeline or dates for training, please share below.

Are there any financial costs to volunteers?

Is there any important or relevant information about transportation and parking that UC students should be aware of?

iFrame Code

Click the button below to caopy your embed snippet

iFrame code