Organization Name Organization Address Street Address City/State ZIP Code Contact Person's Name First Last Contact Person's Phone Number ###-###-#### Contact Person's Email Address Brief Description of Organization Brief Description of Specific Project What kind of opportunity do you want to provide? Volunteer Opportunity Internship (Paid) Internship (Unpaid) Brief Description of Proposed Tasks for Student Will the student be working with minors? Yes No Does the student need to complete a background check? Yes No Does the student need to provide their own transportation? Yes No Does the student need health immunizations? Yes No What kind of commitment are you looking for? Long-term/ongoing Fixed term (please specify below) Fixed term dates (if applicable) How many hours per week will the student be working with you? How many students are you looking for? How should the student(s) contact your organization? Will you provide training for students? If so, what kind (be specific)? What will students learn from their experience? Is there anything else we ought to know?