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

Please upload your signed Collaboration Agreement PDF file here. The agreement must be submitted along with the intake form.

Community Partnerships

Organization

Primary Site Representative Contact Information

Secondary Site Representative Contact Information

Collaboration Agreement