If you would like to hear more about upcoming events, seminars and projects at Emory, please tell us how we can contact you. If you are looking for assistance from an Emory resource, please fill in the top contact information, and then go to the bottom of this form.

Please note that all fields on this form are required.

My name is:

(First Name)
(M.I.)
(Last Name)

I'm particularly interested in:
Issues
 Civic Engagement  
Advocacy
Community Outreach
Fundraising
Organizing
 Cultural and Recreation  
Cultural
Entertainment
 Education and Learning  
Education
Literacy
Mentoring
Scholarship
Tutoring
 Environment  
Advocacy/Community Education
Environmental Justice
Recycling
 Faith-Based  
Pastoral Care and Counseling
Social Ministry
 Health  
AIDS
Disability
Health Care
 Housing and Community Development  
Community Development
Economic Development
Homeless
Housing
Neighborhoods
 Human Services  
Children and Families
Counseling
Elderly
Hunger
Mental Health
Substance Abuse
Welfare
 International  
Immigrant Communities in Metro Atlanta
International Outreach and Service
 Safety and Justice  
Community policing
Law
Violence Prevention
 Women  
Domestic Violence
Equality and Rights
Special Needs and Populations

I am an Emory faculty|student|staff member:

    Yes     No

Please E-mail me at:

(E-mail Address)

My Mailing Address is:
Address Line #1
Address Line #2
Address Line #3
City
State
ZIP
Telephone
 -   - 
Fax
 -   - 

Are You Interested in Partnering With Emory?
    Yes     No

Please briefly describe the activity and the type of assistance you're looking for:

Contact Name:
Check here if same as above.


(First Name)
(M.I.)
(Last Name)

Contact Telephone
 -   - 
Contact Fax
 -   - 

Contact E-mail Address:

(E-mail Address)

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Atlanta, GA 30322
Office of University-Community Partnerships