Community Service Bursary Organization Registration Form printable pdf download

Community Service Bursary

ORGANIZATION REGISTRATION FORM

(Please Print)

Name of Organization:

_____________________________________________________

Mailing Address :

_____________________________________________________

Organization Email:

_____________________________________________________

(Please include as this is our primary means of contacting you)

Organization Phone: ________________________ Fax: ______________________________

Are there any special requirements for your volunteers? (Age, training?) __________________

______________________________________________________________________________

Please provide a detailed explanation about the nature or the volunteer work. (Please refer to

terms and conditions for information on acceptable volunteer jobs)

______________________________________________________________________________

Volunteer co‐ordinator/contact person for the Organization: (this is the person who will be

supervising students and submitting the volunteer hours)

_____________________

_________________________________

__________________

Print Name

Signature

Date

Please return this form by mail or fax to:

Community Service Bursary Program

Department of Workforce and Advanced Learning

Atlantic Technology Centre, 176 Great George Street, Suite 212

Box 2000, Charlottetown, PE C1A 7N8

Phone: (902) 368‐4640 Fax: (902) 368‐6144

Personal information on this form is collected under subsection 32(2) of Prince Edward Island’s Freedom of Information and Protection

of Privacy Act R.S.P.E.I. 1988, c. F-15.01 and will be used for the purpose of Application for Community Service Bursary. If you have

any questions about this collection of personal information, you may contact the Community Service Bursary Program, PO Box 2000,

Charlottetown, PE C1A 7N8, (902) 368-4640.

Community Service Bursary Organization Registration Form