Community Partners

Community Partners
Organization Name*
Industry Type*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Website URL*
Contact Person*

First NameLast Name
Contact Phone Number*
Alternate Contact Phone Number*
Contact Email Address*
example@example.com
Hours of Operation (From)*

:HourMinutesAM/PM Option
Hours of Operation (To)*

:HourMinutesAM/PM Option
Tell us about your service learning opportunity. What specific aspect of this opportunity will be considered service learning (civic engagement)?*
Where will the actual service learning work be performed? Indicate the city*
What Middlesex College majors would align with your organization goals?*
What semester can you accept students?*

FallWinterSpringSummer
Year*
What hours can you accept students or would like students to perform the service learning? (From)*

:HourMinutesAM/PM Option
(To)*

:HourMinutesAM/PM Option
How many students can you accept for the specified semester and year?*
What days of the week can you accept students or would like students to perform the service learning?*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Is your organization accessible by public transportation?*

YesNo
Will you be supervising our students?*

YesNo
Do you prefer to interview students prior to the start of the service learning experience?*

YesNo
Message/Notes*
Should be Empty: