Please complete this agency listing form to enable Community Service-Learning at the University of Maryland, College Park to make your volunteer opportunities available to UM students, faculty, staff, and local community. Your agency's service information will be included in our Servicelink Database (https://was-3.umd.edu/cacs/cspsearch) of over 850 service organizations and programs. You can update your agency's information anytime using this form, but our online database system is updated annually during the summer to maintain the most current information for our volunteers.
AGENCY INFORMATION * Required Fields
Agency/Organization* Department/Division/Program* Address Street* City* State* Maryland District of Columbia (D.C.) Virginia Other Specify Other State Zip*
Contact person for volunteer opportunities* Title Telephone* ( ) ext. Fax ( ) ext. Email* Web Site
Please check appropriate organization description UMCP dept/org Government Hospital Non-Profit Religious School Other Specify Other
Registered with the State of Maryland
Description of Agency/Organization:* Please include a short description of the purpose and focus of the organization/agency. This will ensure that you are entered correctly into our database.
TRANSPORTATION INFORMATION
Parking Availability On street - Free On street - Metered Garage/Lot - Free Garage/Lot - Metered None Not Applicable
Accessible by Metro Rail Metro Line None Selected Red Green Orange Blue Yellow Station Transportation Notes (walking directions, accessible by Metro bus/other, directions from UMCP)
VOLUNTEER OPPORTUNITIES
Please check all of the locations where volunteers with your organization can serve:
Other
What population(s) does your organization/agency primarly serve? Please check only up to three.
What type of service would volunteers participate in? Check all that apply.
Volunteer Opportunities available for Both Individuals & Groups Individuals only Groups only Group Size to
Do you provide opportunities for students to volunteer: One-Time On-going Both One-Time & On-going
Volunteer opportunities for University of Maryland students Only Paid positions for students
Please contact us at (301) 314-CARE or terpservice@umd.edu with any questions, problems, or to update this information at any time. Thank you for your time & information!
Signature* Title
Date January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2008 2009 2010
The University of Maryland, College Park is an equal opportunity institution with respect to both education and employment. The College Park Campus' policies, programs, and activities conform to pertinent federal and state laws and regulations on non-discrimination. Furthermore, the campus Human Relations Code prohibits discrimination on the basis of race, color, creed, sex, sexual orientation, marital status, personal appearance, age, national origin, political affiliation, physical or mental disability, or on the basis of the exercise of rights secured by the First Amendment of the United States Constitution. Community Service-Learning, 7/25/08
Before you submit*, you may want to retain a copy of this completed form for your records. Please PRINT these pages before submitting.