Technology Consulting in the Community - Potential Community Partner Sign-Up Form

Thank you for your interest in being Community Partner.

Please first read the detailed "How It Works" section for Partners before completing this form, which lists requirements, caveats, and expectations for the program.

Organization Name

Street Address

City

State

Zip

Website (if any)

Please describe your organization's mission

Please list your organization's programs

Primary contact person at your organization for this partnership:

Salutation

First Name

Last Name

Job Title

Email

Work Phone

Mobile Phone

Fax

What technology decision making responsibilities is this person in charge of?

What are the issues, problems, ideas, or projects that your organization would like to explore with the student consultant? You may be as specific or general as you would like.

What days and times each week would be best suited to scheduling regular meeting times. This can be as detailed or as general as your schedule allows.

Please list any PAT bus routes that stop near your organization, and provide any other suggestions you may have for students traveling from Carnegie Mellon to your work site.

As a community partner, my responsibilities are to:

Invest your time - there is no financial cost to be a Community Partner.
Attend the Community Partner Orientation Meeting at the Carnegie Mellon University campus (Wednesday, February 1,2012, 9:30am - 11:50am OR Thursday, February 2, 2012, 9:30am - 11:50am).
- Your presence at this meeting is critical the a good start with the program. Please indicate in the comments box below if you have a constraint on either of these days.
Meet and work with the student each and every week for 3 hours (includes time with additional key staff depending on tasks).
Read interim project reports prepared by Student Consultant and provide them with feedback within 2 days.
Complete a brief Feedback Form after reading each report and submit it to the faculty instructor.
Keep Work Logs of consulting sessions and submit to faculty instructor twice during the semester.
Read the final consulting report, providing feedback to Student Consultant within 2 days, and submit Feedback Form to the faculty instructor giving approval to publish the report.
Make a brief presentation with the Student Consultant at the end of the semester at the Community Technology Forum at the Carnegie Mellon University campus (Friday, May 11, 2012, 8:30am - noon OR noon - 3:30pm) and stay for the entire session to hear other partnership presentations.
- Your presence at this full session is critical to the program. Please let me now in the comments box below if you have any constraints on that day.

Please check the box below if you agree to the above requirements. If you cannot meet the above requirements, do not check the box below and we will still consider you for a future semester.

Check only if you agree

Please list any additional questions or concerns