Please complete the following information to be used in our publications, guides, and website.

Name of Agency: ____________________________________________ Date: ____________ CONTACT INFORMATION Mailing Address: ________________________________________________________________ City: ______________________________ State: ___________________ Zip: _______________ Phone Number: __________________________ Fax Number: ___________________________ Web site: ______________________________________________________________________ EIN # (Required): ____________________________ EXECUTIVE DIRECTOR Name: ________________________________________ Email: __________________________ VOLUNTEER CONTACT Name: ________________________________________ Email: __________________________ Position: ______________________________________ BOARD MEMBERS (Information Not Shared) Name: Board Position: Email: 1.______________________ _________________ _________________________________ 2.______________________ _________________ _________________________________ AGENCY MISSION (Or describe your organization in 25 words or less.)

AGENCY PARTNER MEMBER PROFILE FORM

AGENCY VISION

AGENCY IMPACT (Please include 1-2 statistics about how your organization impacts the community)

SOCIAL MEDIA ( Does your organization use any of the following?)

____ Facebook

____ Twitter

____ YouTube

AGENCY VOLUNTEER INFORMATION

Please complete this page in order to help the Volunteer Center of Lubbock accurately connect volunteers and better serve your agency. If your organization has not established a Volunteer Lubbock account one will be created for you. Call or email for more information or training.

Name of Agency: ______________________________________________________________ VOLUNTEER OPPORTUNITIES (Please describe opportunities at your organization in 40 words or less.)

____ Animals/Animal Care ____ Arts & Crafts ____ Boards/Committees ____ Child Care ____ Civic Engagement ____ Clothes Closet/Thrift Store ____ Collecting/Delivering/Sorting ____ Computer & Office Work ____ Counselors/Crisis Assistance ____ Disaster/Emergency Assistance ____ Evening Opportunities ____ Family Opportunities ____ Group Opportunities

VOLUNTEER INTEREST CATEGORIES

____ Financial Education ____ Fix-Up and Clean Up ____ Fundraising/Special Events ____ Games & Sports ____ Gardening ____ Health/Medical ____ Legal/Court Related ____ Mentoring ____ Serve/Prepare Food

VOLUNTEER OPPORTUNITY TIMES

____ Summer Opportunities/Programs ____ Weekend Opportunities ____ Youth Opportunities

NATIONAL DAYS OF SERVICE

____ Wed like to participate with a volunteer project on the National Days of Service
INTERNSHIPS Do you offer internships for college students? ____ Paid Internships ____ Unpaid Internships COURT APPOINTED COMMUNITY SERVICE Do you accept court appointed community service? ____ Yes Exceptions:

____ No

VOLUNTEER STATISTICS (# of volunteers & volunteer hours last year?) Cost of Partnership is $100. Return both forms with payment to the Volunteer Center of Lubbock Mail: 1706 23rd St., Suite 101. Lubbock, TX 79411 E-mail: volunteer@volulnteerlubbock.org Fax: (806) 747-8640
Click to Submit

Questions? Suggestions? Need an Invoice? Jason Fischer: (806) 747-0551 or jfischer@volunteerlubbock.org