Middlesex County College Service Learning Partner Survey

Middlesex County College is committed to our service learning initiative and in partnering with local organizations. Kindly complete the requested fields, so that we can best help you meet your community needs.

Service Learning Program

* indicates that this is a required field

ABOUT YOUR ORGANIZATION

Organization Name : *

Industry Type : * Faith-Based Organization Public Service/Public Interest Neighborhood Association Voter Registration Political Campaign Community-Based Mentorship/Tutoring Conservation Environmental Other

Street Address : *

City : *

State : * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Web URL : *

Contact Person : *

Contact Phone Number : *

Alternate Contact Phone Number :

Contact Email Address : *

What are your hours of operation?

From : *

* AM PM

To: *

* AM PM

SERVICE LEARNING OPPORTUNITY

Tell us about your service learning opportunity. What specific aspect of this opportunity will be considered service learning (civic engagement)? : *

Where will the actual service learning work be performed? Indicate the city : *

What Middlesex County College majors would align with your organization goals?
(Select all that apply - up to 5 majors) * Accounting Addiction Studies Advertising Graphic Design Allied Health Pre-Professional Automotive Technology Baking and Pastry Arts Biology Biotechnology Business Administration Chemistry Civil Engineering Technology Computer Aided Drafting Computer and Information Systems Computer Help Desk Administration Computer Programming Criminal Justice - Correction Administration Criminal Justice - Police Science Culinary Arts Management Cyber Security Dental Hygiene Dietetics Earth Science Education Electrical Engineering Technology Engineering Science Event Planning Management Fashion Merchandising and Retail Management Fire Science Technology Forensic Accounting and Fraud Examination Gaming and Animation Health Science Hotel/Motel Management Java and Web Programming African-American Studies Cinema Studies Communication Dance English Genocide and the Holocaust Global Studies History Journalism Music Philosophy Physical Education/Recreation Political Science Psychology Social and Rehabilitation Services Social Sciences Sociology Theatre Writing Management Marketing Mathematics Mechanical Engineering Technology Media Arts and Design Medical Laboratory Technology Network Administration and Support Nursing Paralegal Studies Photography, Professional Commercial Physics Process Technology Psychosocial Rehabilitation and Treatment Public Health Radiography Restaurant Operations Restaurant/Food Service Management Small Business Management/Entrepreneurial Studies Surveying Engineering Technology Windows/PC Support

What semester can you accept students?

Semester : * Fall Spring Winter Summer

Year : * 2016 2017 2018 2019

What hours can you accept students or would like students to perform the service learning?

From : *

* AM PM

To: *

* AM PM

How many students can you accept for the specified semester and year?

What day of the week can you accept students or would like students to perform the service learning? * Monday Tuesday Wednesday Thursday Friday Saturday

Is your organization accessible by public transportation? : * Yes No

Will you be supervising our students(s)? *

Yes

No

Name : *

Phone Number : *

Do you prefer to interview students prior to the start of their service learning experience? *

Yes No

Message or Note

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