2006-2007
To be filled out by an authorized representative of the partner organization and student and then returned to The Center for Service and Citizenship.
Position (if applicable)
Organization
Web site address
Street address
City, state, zip
Duration of assignment: __/__/__ to __/__/__
Approximate Number of hours per week: ______
Supervisor Name
Title
Phone
Email
Supervisor signature __________ Date __________
Student Name __________
Student Signature __________ Date __________
This form must be returned to the Center for service and citizenship before students can begin working!