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Meeting Space Reservation
Room Choice
(Required)
Board Room
Dr. Dan Weldon Conference Room
Type of Meeting
(Required)
In Person
Hybrid
Preferred Date
(Required)
Month
Day
Year
Backup Date
(Required)
Month
Day
Year
Reservation Start/End Time
(Required)
Please include setup and take-down time in your reservation.
Number of Attendees
(Required)
Purpose
(Required)
Please describe the gathering.
Organization
(Required)
Employer Identification Number (EIN)
(Required)
Contact Person
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Mobile Phone
(Required)
Email
(Required)
Proof of 501(c)(3) status
(Required)
Max. file size: 2 GB.
Please upload a scan of your organization's 501(c)(3) status document.
Additional comments about your reservation and/or equipment needs
Representative Signature
(Required)
Date
(Required)
×
SYC Emergency Contact Form
Name
(Required)
Emergency Contact Person
Relationship
Best Phone Number for Emergency Contact
Secondary Phone Number for Emergency Contact
Back-up Contact Name(s)
Please list name(s)/phone number(s) of any other individuals we could call in an emergency in case your primary contact is not reachable.
Back-up Contact Name(s) & Number(s)
Health Conditions/Allergies
Do you have any allergies or health conditions that we should be aware of?
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Host Agency Application
Agency
Agency Website
Agency Address
Contact Name
Email Address
Phone #
Agency Description/Mission
Service-Learning Opportunities & Potential Intern Assignments
Please describe the activities/duties you would anticipate for an intern. Include one to three measurable outcome goals for the internship.
Days/Hours of Agency Operations
What days/hours would the intern work most weeks?
Additional Information and/or Special Conditions or Requirements of Intern, such as regular travel between agency locations.
Intern Supervisor
Please provide name/information for one primary supervisor who will be responsible for managing the intern and communicating with FCP.
Intern Supervisor's Resume or Qualifications
Max. file size: 2 GB.
Please upload a copy of your organization's 501c3 status.
Max. file size: 2 GB.
Please upload your organization's liability insurance certificate, showing coverage for student/interns/volunteers.
Max. file size: 2 GB.
Does the organization, or any of its officers or directors have a personal, financial, or employment relationship with Foundations Community Partnership?
Yes
No
If yes, please describe the nature of this relationship:
Representative Signature
Date
×