Agency Information

Name of Agency [Required] :


Contact Person [Required] :


E-mail [Required] :

Phone Number [Required]:       Facsimile Number:

Address [Required] :    

City [Required] : State [Required]:   Zip [Required]:

Web Site URL:

Time the Agency Opens: [Required]  Closing Time: [Required]

Type of Agency [Required]: Choose One City Government Government Hospital Non-Profit Religious Institution School   # of Volunteers Needed [Required]:

Mission of the Agency [Required]:    

View other agencies partnered with the ACSLP in the Agency Book.
Note: This is a PDF file requiring the popular, free Adobe Acrobat Reader.


Volunteer Position Information

Volunteer Position Title [Required]:

Location of Service to be Performed [Required]:

Volunteer Start Date [Required]:   End Date [Required]:

Number of Hours [Required]:   Time Preference [Required]:

Volunteer Position Description [Required]:

Volunteer Duties [Required]:

Training-Supervision Provided [Required]:


What skills must the volunteer possess [Required]:


How will this activity be meaningful to the volunteers [Required]:

Can you provide transportation for your volunteers? Please Select Yes No

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