Organization Name:
Address 1:
Address 2:
Telephone Number:
Website Address:

Name of Volunteer Coordinator or Contact Person:

E-mail Address :

Please check one of the following:
Yes, my organization will sponsor a Shipley student volunteer.
No, we are unable to host a Shipley student volunteer.
I am uncertain at this time. Please call me back.

Number of Shipley volunteers you can accommodate:

Duties required of the volunteer: (Please be specific):

Special skills that would be helpful for a volunteer to have:

Typical hours of employment:

Are there any special circumstances that we should be aware of (i.e. travel required as a part of the volunteer experience, security clearance or background check required, etc.)?

Additional information that would help in matching volunteer to your needs: