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Madison House

Community Partner Inquiry Form
Please complete this form on behalf of your organization if you are interested in forming a collaborative partnership with Madison House! Thank you!

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Your Information

First Name *

Last Name *

Email Address *

Phone Number

Organization Name *

Organization Point of Contact Name *

Organization Point of Contact Email *

Organization Point of Contact Phone Number *

Organization Website (Link) *

Please put "N/A" if your organization does not have a website.

What population or focus area does your organization primarily serve? *

Children and Youth
Adults
Animals
People Experiencing Homelessness
Immigrants, Refugees, and other Ethnic Groups
People with Health-Based Concerns
LGBTQ
The Environment
Other

If you selected other, please indicate the population that your organization serves *

If this does not apply, please put "N/A"

What form of service best fits your organization? *

One-time Volunteers
Recurring and Committed Volunteers
Building Relationships Across UVA

Are there any specific skills you would want volunteers to have? *

What makes (or would make) Madison House an ideal partner for your organization? *

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