This site is accessible using any internet enabled device but will look best in a modern graphical browser that supports web standards.

Jump To: Content | Navigation

If you work for a local nonprofit agency and would like to explore a service learning partnership with Loyola, please fill out the form below.

Name of Agency *
Your Name *
Your Title *
Email *
Phone *
Street Address *
State *     Zip *
Does your agency operate programs at locations or sites other than the address listed above? *
   Yes           No
If Yes, where?
Briefly describe the programs in which Loyola service learning students might be involved and the tasks they might perform.

What do you think a Loyola student could learn from working at your agency?

 
Times and days when you have a HIGH need for volunteers. Check all that apply.
  Monday   Tuesday   Wednesday   Thursday
  Friday   Saturday   Sunday   Weekdays Only
  Weekends Only   Mornings   Afternoons   Evenings
  All days & times   Various    
 
Times and days when you have a LOW need for volunteers. Check all that apply.
  Monday   Tuesday   Wednesday   Thursday
  Friday   Saturday   Sunday   Weekdays Only
  Weekends Only   Mornings   Afternoons   Evenings
  All days & times   Various    
 
Times and days when you CANNOT host volunteers. Check all that apply.
  Monday   Tuesday   Wednesday   Thursday
  Friday   Saturday   Sunday   Weekdays Only
  Weekends Only   Mornings   Afternoons   Evenings
  All days & times   Various    
 
What is the best way for a Loyola student to get to your site(s)? Check all that apply.
 Within walking distance  Within biking distance  Students would need to
      drive
 Convenient to a bus line  Convenient to a streetcar
      line		  


Updated September 19, 2008


Warning: require_once(assets/shared/ssi/tracker.www.php) [function.require-once]: failed to open stream: No such file or directory in /html/srvlearn/public_html/interested_agency_form.php on line 358

Fatal error: require_once() [function.require]: Failed opening required 'assets/shared/ssi/tracker.www.php' (include_path='/usr/local/apache/php') in /html/srvlearn/public_html/interested_agency_form.php on line 358