Service Site Registration
California State University, Northridge offers community service sites and
organizations the opportunity to be a part of our online volunteer opportunities
database. All CSUN students have access to this database in which they can search
for meaningful and fulfilling volunteer opportunities. Please note that the more
information you provide us with, the better our students will be able to find your site.
To ensure that both CSUN and the community organization observe all rules,
regulations and procedures in place with respective organizations, we will host a
Community Organization Partnership Training, we advise that you designate a
representative to attend. Should you have any questions please contact Beatriz Trejo
at (818) 677-5111 or beatriz.trejo@csun.edu
Please Print Clearly
Please check one:
New site registration
Site information update
Organization Name: __________________________________
Parent organization? Circle: Y N
If yes, please list the organization name: ____________________________
Scope, circle:
International
Type of agency:
Non-profit
National
Regional/State
Government
School
Local
Other
Street Address: _________________________________________________
City: ______________________State: ____ Zip Code: ___________
Phone Number: _______________________________
Fax Number:__________________________________
Contact Person:____________________ Contact’s Position____________________
Email Address:_____________________ Web Address:_______________________
What is the minimum number of hours you would require of a student in service?
1-5
6-10
11-15
16-20
21-25
26-30
30+
During what days and hours will you accept students for service?________________
___________________________________________________________________
Are there specific departments, faculty, or academic major with whom you would like
to be partnered?______________________________________________________
Services Provided (check all that apply)
Advocacy
Employment Training
Legal
AIDS /HIV
Environment / Conservation
Literacy
Animal Care
Ethnic Awareness
Mental Health
Arts
Faith - based
Mentoring
Blind
Family
National Service
Children
Gay and Lesbian
Other
Civic Responsibility
Health
Politics
Community Building / Development
Homelessness
Poverty Relief
Disability Awareness
Housing
Seniors
Domestic Violence
Human Rights
Substance Abuse
Education (Post-Secondary)
Human Services
Violence Prevention
Education (Primary)
Hunger
Women
Education (Secondary)
International Service / Aid
Youth Programs
Emergency Assistance
Mission Statement
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Inherent Risks
Please list all known risks inherent to the students’ service environment associated
with your organization (facility hazards, locations concerns, client or personal issues,
etc.). In addition, should additional risks become identified, the agency must agree
to communicate all risk-related concerns immediately to the supervising faculty
member.
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Other notes or comments about the organization
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Position
Title:__________________________________________
Description:__________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
What will volunteers be doing? (Check all that apply)
Accounting / Bookkeeping
Graphic Arts / Design
After School Programs
Healthcare - Direct
Animal Care / Rights
Healthcare Administration
Arts and Crafts Instruction
Language Translation (Foreign or Sign)
Biology / Science
Legal
Board or Committee Member
Lobbying / Policy Making
Classroom Assistance
Mentoring / Tutoring
Computer Assistance / Instruction
Performing Arts
Computer Programming / Web Development
Photography
Construction / Landscaping
Preparing and Delivering Food
Counseling
Public Relations / Marketing
Data Entry and Office Work
Public Speaking / Education
Dentistry
Research
Driving / Transportation
Sports & Recreation
Event / Project Coordination
Writing / Editing
Fine Arts
Youth Programs
Fundraising / Grant Writing
What personal interests should the volunteer have?
(check all that apply)
Other
Social Health
Human Rights
Animal Rights
Education
Gay & Lesbian
Beautification / Renovation
Health
People with Disabilities
Faith Based
Homelessness & Poverty
Protecting
International / National Programs
Substance Abuse
Seniors
Politics / Government
Women's Issues
Youth
Children
Health & Education
Mentor
Rights of
Nurture
Serve
Prepare
Environment
Protect
Please return this from to:
Matador Involvement Center
California State University, Northridge
18111 Nordhoff Ave
Northridge, CA 91330-8344
Or electronically to:
Beatriz.Trejo@csun.edu
Protection, Rehabilitation, etc...