Online Web Form

Community Partner Profile and Student Request Form
Many organizations find that working with college students allows them to expand the capacity of their organization or agency while allowing them to provide students with an opportunity to have positive learning experiences. Through service-learning and volunteering, students are able to examine the role of community organizations and contribute to them.

The Center for Community Service-Learning and the Volunteer Program have many connections to students, student clubs and organizations, and faculty members across the campus. We will do everything possible to locate the right students to meet your needs. If you would like our assistance in identifying students to work with your agency, please fill out this request form or print the PDF version and fax it to (818) 677-5935.

Basic Information
Community Organization:
Type of Organization:	Non-Profit Government School Other
Executive Director:
Preferred Contact:
Address:
Phone Number:
Fax Number:
Email:
Web Address:

1. Briefly describe the mission of the organization/agency. Who is served? In what capacity?

2. Briefly describe any ongoing needs or special projects with which students can assist agency staff.

3. What is the minimum number of hours you would require of a student in service?   1-5 6-10 11-15 16-20 21-25 26-30 30+   Other:

4. During what days and hours will you accept students for service?

5. Are there specific departments/faculty with whom you would like to be partnered?

Service Locations

(1) Site Name:     Supervisor(s): Primary   Secondary     Phone Number:     Fax Number:     (2) Site Name:     Supervisor(s): Primary   Secondary     Phone Number:     Fax Number:

Inherent Risks

Please list all known risks inherent to the students’ service environment associated with your organization (facility hazards, location concerns, client or personnel issues, etc.). In addition, should additional risks become identified, the agency must agree to communicate all risk related concerns immediately to the supervising faculty member.

Please initial here in acceptance of this requirement:

Partnership Training:

To ensure that both CSUN and the community organization observe all rules, regulations, and procedures in place with their respective organizations, we require that a designated representative attend a Community Organization Partnership Training. Please initial below in acceptance of this requirement:

Our organization will designate at least on representative to attend a Partnership Training.

Please send any additional rules, regulations, and/or procedures of your organization that our students are expected to follow during our partnership to csl@csun.edu or fax to (818) 677-5935 attention Curtis Woods. Once this form is received, a representative will send an email confirmation to the preferred organization contact listed above.