Service Learning Partnership In-take Form

Name *

Mission *

Website

Please provide your Federal Tax ID/EIN Number

Are you Exempt 501c3 approved? *

Yes

No

International Address? *

Yes

No

Address Line 1 *

Address Line 2

City *

State

Zip Code *

Country

Address Line 1 *

Address Line 2

Address Line 3

City *

State/Province/Region

Zip Code *

Country *

Does your organization require its volunteers to complete a background check? *

Yes

No

If yes, please specify what type of background check and time needed for approval

First Name *

Last Name *

Title

Phone Format: (###) ###-#### *

Email Format: ex.name@domain.com *

Preferred Contact Method

Phone

Email

First Name

Last Name

Title

Phone Format: (###) ###-####

Email Format: ex.name@domain.com

Preferred Contact Method

Phone

Email

How did you hear about us?

Other

Have you already met with someone from the Steans Center? *

Yes

No

If yes, please enter their name(s) *

Are you an internal DePaul University program or department? *

Yes

No

If you are ready to submit a signed Collaboration Agreement, please upload your PDF file.

Community Partnerships

Organization

Primary Site Representative Contact Information

Secondary Site Representative Contact Information

Collaboration Agreement