Thank you for your interest in participating in the Dallas County Community College Service-Learning program. Please take a few minutes to complete the information below so that we have accurate information regarding your agency/organization.
Agency Name* Contact Person(s)*
Address: City: Zip: Phone*
Mailing Address (if different):
Description of Volunteer Service:
Please indicate information regarding your orientation for students.
Day: Date: Time: to Place:
Are you scheduling individual orientations instead? Yes Both
Maximum number of students you can place: (minimum is 5) Times students can work:
Are you a non-profit site? Yes No
Any special requirements? (age, sex, application, uniform cost)
Do you have placement opportunities for students with hearing or vision impairments?
If students miss the orientation and you have not yet reached your maximum number of students, will you still take students? Yes No
Do you have liability insurance that covers volunteers? Yes No
Dallas County Community College District