University of Pittsburgh

Community Outreach Partnership Center

Agency Profile Questionnaire

This questionnaire is designed to update the contact information for each of the partner agencies within the Community Outreach Partnership Center. Please complete the fields below and return to

Thank you for your participation!

Organization Name:
Organization Address:
Organization Phone:
Organization Email:
Executive Director:
Executive Director Contact Information:
Volunteer Coordinator:
Volunteer Coordinator Contact Information:
Other Officers or Board Members to be Listed:
Organization Mission:
Organization History:
Who Does the Organization Benefit? (Ex. Children under 10 in Hazelwood, Elderly residents of Oakland, etc.)
Does the Organization Administer Multiple Programs? (If so, please list and describe each.)
Please List the Areas Affected by the Organization and its Projects: (Ex: Oakland, Hazelwood, etc.)
Please Select Which Areas the Agency is Classified:
¨  Adult Education (General)
¨  Advocacy
¨  Children & Youth
¨  Community Development
¨  Community Outreach
¨  Disaster Relief
¨  Economic Development / ¨  Elder Care
¨  Entrepreneur/Business
¨  Environment
¨  Ex-Offender Reentry
¨  Health
¨  Homeland Security
¨  Homelessness / ¨  Housing
¨  Hunger
¨  Literacy
¨  Neighborhood Revitalization
¨  Public Safety
¨  Technology
¨  Other
______
______
Does the Agency Regularly Recruit Volunteers for On-Going Projects?
What Knowledge and/or Skill Areas Would Students Ideally Possess to Volunteer?
Prior experience in:
¨  Adult Education (General)
¨  Advocacy
¨  Children & Youth
¨  Community Development
¨  Community Outreach
¨  Disaster Relief
¨  Economic Development / ¨  Elder Care
¨  Entrepreneur/Business
¨  Environment
¨  Ex-Offender Reentry
¨  Health
¨  Homeland Security
¨  Homelessness / ¨  Housing
¨  Hunger
¨  Literacy
¨  Neighborhood Revitalization
¨  Public Safety
¨  Technology
¨  Other
______
______
What Knowledge and/or Skill Areas Would Students Ideally Possess to Volunteer?
Fluency or near fluency in:
¨  Arabic
¨  American Sign Language
¨  Chinese
¨  French
¨  German
¨  Greek
¨  Hmong / ¨  Italian
¨  Japanese
¨  Korean
¨  Polish
¨  Portuguese
¨  Spanish
¨  Russian / ¨  Thai
¨  Ukrainian
¨  Vietnamese
¨  Other:
______
What Knowledge and/or Skill Areas Would Students Ideally Possess to Volunteer?
Specialized Skill Experience:
¨  Counseling
¨  Architectural Planning
¨  Business/Entrepreneur
¨  Communications
¨  Community Organization
¨  Computers Technology
¨  Conflict Resolution / ¨  Education
¨  Arts/Crafts
¨  First Aid
¨  Fundraising/Grant Writing
¨  Law
¨  Leadership
¨  Medicine/Public Health / ¨  Recruitment
¨  Teaching/Tutoring
¨  Trade/Construction
¨  Writing/Editing
¨  Youth Development
¨  Other:
______
Is there anything else that should be noted regarding the agency?

COPC Partner Profile June 2008 Page: 2