Community Partner Agency Registration
University of South Carolina 2012 Community Partner Breakfast
Monday, October 8th 7:30 a.m. – 9:00 a.m.

Name:
Job Title:
Email Address:
Work Phone:
Agency You Represent:
Agency Address:
City:
State:
Zip:
Number of Guests Attending (maximum of two per agency please):
Additional Guest Name:
Additional Guest Title:
 
1. Please describe any current/ongoing or new tasks/projects for which you currently need volunteer assistance. Specifically consider those items that would be ideal for partnerships with University of South Carolina students and faculty.
 
2. What are some of the “big picture” issues students are likely to be exposed to while working on projects with your organization? For example, students will learn about the social and economic factors that contribute to homelessness while volunteering at our overnight shelter.
 
3. Special Notes or Comments:
I understand that some of this information may be shared with other participants during the Community Partner Breakfast to better facilitate connections. Note: Your phone number will not be shared. It will only be used to remind you of the event.
 
The University of South Carolina is committed to providing equal opportunity for participation in all programs, services, and activities. Accommodations will be made for persons with disabilities. Requests received after September 28, 2012  will be honored whenever possible. Please indicate below any accommodations (including specific dietary restrictions) we should address so that you are able to participate in this program: