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Agency Partner Form
Agency Partner Form
Name of Agency: ____________________________________________ Date: ____________ CONTACT INFORMATION Mailing Address: ________________________________________________________________ City: ______________________________ State: ___________________ Zip: _______________ Phone Number: __________________________ Fax Number: ___________________________ Web site: ______________________________________________________________________ EIN # (Required): ____________________________ EXECUTIVE DIRECTOR Name: ________________________________________ Email: __________________________ VOLUNTEER CONTACT Name: ________________________________________ Email: __________________________ Position: ______________________________________ BOARD MEMBERS (Information Not Shared) Name: Board Position: Email: 1.______________________ _________________ _________________________________ 2.______________________ _________________ _________________________________ AGENCY MISSION (Or describe your organization in 25 words or less.)
AGENCY VISION
AGENCY IMPACT (Please include 1-2 statistics about how your organization impacts the community)
____ Facebook
____ Twitter
____ YouTube
Please complete this page in order to help the Volunteer Center of Lubbock accurately connect volunteers and better serve your agency. If your organization has not established a Volunteer Lubbock account one will be created for you. Call or email for more information or training.
Name of Agency: ______________________________________________________________ VOLUNTEER OPPORTUNITIES (Please describe opportunities at your organization in 40 words or less.)
____ Animals/Animal Care ____ Arts & Crafts ____ Boards/Committees ____ Child Care ____ Civic Engagement ____ Clothes Closet/Thrift Store ____ Collecting/Delivering/Sorting ____ Computer & Office Work ____ Counselors/Crisis Assistance ____ Disaster/Emergency Assistance ____ Evening Opportunities ____ Family Opportunities ____ Group Opportunities
____ Financial Education ____ Fix-Up and Clean Up ____ Fundraising/Special Events ____ Games & Sports ____ Gardening ____ Health/Medical ____ Legal/Court Related ____ Mentoring ____ Serve/Prepare Food
____ Wed like to participate with a volunteer project on the National Days of Service
INTERNSHIPS Do you offer internships for college students? ____ Paid Internships ____ Unpaid Internships COURT APPOINTED COMMUNITY SERVICE Do you accept court appointed community service? ____ Yes Exceptions:
____ No
VOLUNTEER STATISTICS (# of volunteers & volunteer hours last year?) Cost of Partnership is $100. Return both forms with payment to the Volunteer Center of Lubbock Mail: 1706 23rd St., Suite 101. Lubbock, TX 79411 E-mail: volunteer@volulnteerlubbock.org Fax: (806) 747-8640
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