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Prescott
Organization Application to Participate in Federal Work-Study Community Service Program
The Prescott College Student Employment Program invites you to complete the following profile so we may evaluate your organization’s eligibility to participate in the Federal Work-Study Community Service Program. All information provided on this secure form will be used for internal purposes only and will remain confidential.
1. Your Name
2. Your Email Address
3. Name of Organization
4. Telephone
5. Address
6. City/State/Zip
7. IRS Exemption Number
8. Owned/operated by
9. Nature of business and description of goods or services provided and organization statement of purpose
10. Describe composition of Board of Directors/Corporation, if applicable
11. Organization source of funding
12. Type of organization (i.e. Non-Profit, 501C-3)
13. Number of years in operation
14. Number of Employees (Full time /Part time)
15. Has the organization ever had a license, certificate of registration to operate a business, occupation of profession denied, suspended or revoked?
16. Does the organization currently posses all licenses, certificates and registrations required by all federal, state and local laws and ordinances?
17. Has the organization ever been a defendant in a consumer protection action?
18. Has the organization ever been involved in a labor dispute?
19. Does the organization participate in any political activity or have any religious affiliation?
20. Comments:
21. Insert a link to your organization's website, showing the published mission statement.
Please send a copy of your IRS Exemption letter to the Student Employment Coordinator at maryann.deminsky@prescott.edu.