On-Line Agency Registration and Update Form
	Let us know about your agency and volunteer needs.  We publish this information in print and online agency guides to help volunteers find you.   Please provide the following contact information (physical address): Organization Street Address Address (cont.) City State Zip/Postal Code Phone FAX E-mail URL  Please provide your postal address (if applicable): Street Address Address (cont.) City State Zip/Postal Code  Mission statement or description of programs offered: Office hours: Program hours (if different):    Evening and Weekend Projects:  Family and Group Projects:  Holiday Projects:  Please indicate any material needs of your organization.    Volunteer activities/duties description (note any training required or provided in parentheses):  Indicate the days and times volunteers are needed. Mon.  Tue.  Wed.  Thu.  Fri.  Sat.  Sun.        Indicate the times of day volunteers are needed. Mornings   Afternoons   Evenings        Minimum time required of volunteers (ex: 'x' hrs at a time; an 'x' month commitment, etc.):  Age requirement for volunteers: Other information (ex: special programs, background checks, message to potential volunteers, etc.):  Agency director's information (Required for our records only): Full Name Phone  Volunteer coordinator's contact information (Required for our records only): Full Name Phone E-mail Copyright © 2005 [United Way of Southeast Mississippi]. All rights reserved. Revised: January 23, 2007
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