Streetfest - Agency Participation Form

Please complete and submit this form if your agency would like to participate in the Service-Learning Center Streetfest project.

Agency Name:

Primary Contact Person:

Secondary Contact Person:

Address:

Phone :

Fax:

Agency E-mail:

Personal E-mail:

Agency Web Site Address (if available):

Dates we can host groups for Streetfest (check all that apply):
, 11:30 a.m. to 3:30 p.m.


We can host a group size of:

Type of Projects (select all that apply
[CTRL+Click Mouse]):

Project Details:

Our work site is universally accessible: Yes No

We are able to accommodate students with visual and/or audio impairment: Yes No

Gloves will be required at the work site: Yes No

Address of actual Streetfest service project location:

Nearest main street intersection:
AND

Comments/Questions: