Community Partner Request for a Community-Based Learning Program Fellow

The Weissman Center for Leadership and the Liberal Arts and the CBL Program look forward to working with you and your organization. Please complete and submit the form below. If you have any questions, please contact the CBL office in 122 Porter Hall at (413) 538-3428 or email CBL.

CBL Fellows are Mount Holyoke undergraduate students and they are available during the academic year. The community-based organizations with whom our fellows have worked previously have been in fields such as economic development, housing, adult education, after school programs, child care, health care, and environmental justice.

The duties and projects of the CBL Fellow will be determined by the needs of the community agency with which she is affiliated and also be shaped by the interests, skills, and experiences that she has. Other responsibilities involve keeping accurate records, maintaining regular contact with the CBL office, and developing informative summaries of projects. Fellows usually work with their community partner organization for an entire academic year and often return for additional year-long affiliations. The fall semester usually runs from September through mid-December, and the spring semester runs from February through mid-May.

Required fields are marked with *.

Organization Name*

Director(s)*

Address*

Contact person (if different than Director)

Organization mission statement (You may attach as a separate document if needed)
Submit here or attach document.

In what ways do you hope a CBL Fellow will contribute to your organization? What role(s) would the CBL Fellow play in the organization?*

Please describe at least two projects on which the CBL Fellow would be working.*

Please note the expected working arrangements for the CBL Fellow. On-site? Off-site? Will she need to travel locally as part of her arrangement?*

You are requesting a CBL Fellow for: *

	Fall only
	Spring only
	Fall & Spring

Please note any previous partnerships with a Community-Based Learning Program within the 5-Colleges.*

Please note any Mount Holyoke professor and/or students with whom you have worked in the past.*

Please list any questions you may have about the CBL Program.*