Rutgers Community Service Survey

Program/Organization Name:

Street Address:


Phone Number:
Fax Number:
World Wide Web URL/Address :

Academic Department Affiliation:

Contact Name:
Title/Position:
e-mail Address:
Phone ext.:

Part I: Your Program/Organization and Participants

This area covers the focus of your program/organization and its participants.

(a) Please provide a brief description of the purpose of your program/organization and the services it provides to the community:

For questions (b) through (f), please check all boxes that apply.

(b) Which of the areas listed below best describes your program/organization's involvement with community?
Culture and Arts
Day Care
Diversity
Economic Development
Education
Employment
Food/Hunger
Health
Housing
Recreation
Social Services
Transportation
Women's Issues
Other, please specify:

(c) Which population group does your program/organization work with?
Youth
Adults
Senior Citizens

(d) Services provided by your program/organization are given primarily by:
Undergraduate students
Graduate students
Faculty
Staff

(e) Is there a fee for your services?
Yes
No

(f) List, if any, the eligibility restrictions for your services:
Income
Other restrictions, please specify.

(g) What are the campus sources for your volunteers? (e.g. Fraternity/Sorority System, Livingston College, Agriculture students; please be specific.)


Part II: Your Organization's Work In New Brunswick

This addresses your program/organization's work in the New Brunswick community and your interest and resources available to start new projects.



(a) Please list current community service projects in New Brunswick. For each, include a project name and description (include, if possible, levels of interaction, e.g. contact hours, # of volunteers):


(b) Please list the groups your program/organization has worked with (both internal: Rutgers-New Brunswick Programs/Organizations and external: City of New Brunswick based agencies, organizations, schools, churches etc.):


The next question addresses grant writing. Your responses can beused to create networking opportunities and improve our fundraising abilities. These questions are optional.

(c) What specific government and foundation grants and their sources have you successfully acquired for your community projects?


(d) What resources does your program/organization have available to offer a community service project in New Brunswick? (Check all boxes that apply.)
Write proposal/grants
Knowledge of community contacts
Volunteers
Academic experience, (please specify field)
Professional experience, (please specify field)
Technical assistance, (please specify)
Other, (please specify)

(e) Describe any additional areas of interest or initiatives your program/organization would like to pursue in New Brunswick:


Part III concerns general information about your program/organization

(a) Please list any of your program/organization's handbooks/guides: (Please send if available.)



(b) Provide any additional information or comments you feel would be useful.