Faculty/Staff/Administrator Electronic Form

Are you engaged in the community through a community-service program or project, or personally/professionally as a board member, consultant, or volunteer? If so, we would love to hear your story and learn more about your work.

Help us recognize and celebrate the breadth of our community engagement by filling out the form below. Feel free to offer as much information as you are comfortable sharing. Your responses will help us facilitate greater coordination of our outreach projects, strengthen existing partnerships, and report on the collective impact of the University community on the greater community. Your good work is important to us - and could be a catalyst for others.

Thank You!

Please fill out the form as completely as possible. Fields marked with a * are required.

* Your Name:

* Department/Program:

* Building:

* Room/Location:

Phone Ext:

Contact E-mail:

* Name of Organization:

* City:

* State:

* Type of Organization:

Nature of your relationship with this organization:

Service-learning course
Course Title/#   
# Semesters Taught   
Supervise, facilitate program
Board member

* Time with Organization:

* Hours volunteered weekly:

Description of the partnership
(ex. description of service learning work, you personal involvement as volunteer or board member, etc.):

Do you think your partnership with this organization would be helpful to Fairfield University, and if so, how:

Please indicate which of the following ways your affiliation with this organization could be expanded or strengthened by linking it with other efforts at the university.
(Please mark all that apply)

Service-learning opportunities
Student volunteer opportunities
Student internship opportunities
Student work study opportunities

*Are you interested in talking with someone about expanding on this community outreach effort/relationship/partnership?

If you responded Yes above, please respond to the following:

Can we contact you or refer colleagues to you as appropriate?

Can we share this information through the Service@Fairfield webpage

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