Non Profit Off Campus Work study Eligibility Questionnaire

This questionnaire is for Wisconsin non-profit organizations to determine their eligibility as a prospective UW-Madison Federal Work-Study partner.

Complete Name of Organization*
Phone Number of Organization*
Contact Name (please list the first and last name of the person you want us to reach out to about work study eligibility)*
Email Address (please list the email you want us to reach out to about work study eligibility)*
Address of Organization*
Street Address Address Line 2 City State ZIP Code
Name of Organization Director*
First Last
Organization Director Email Address*
Address of Organization Director (if different from above)
Street Address Address Line 2 City State ZIP Code
My organization is a part of the SuccessWorks Community Impact Internship Program?*
- Yes
- No
My organization is a registered and certified 501c3 non profit?*
- Yes
- No
Through what sources is this organization funded? (please indicate by percent each source is funding your org)*
What is the purpose and general function of this organization?*
For what types of jobs do you intend to hire Work-Study Program students?*
What groups, populations and/or agencies does your organization serve?*
What need(s) in the community does your organization serve?*
What eligibility criteria do you use in selecting your clients or target groups?*
Are there any membership requirements? (Please be specific)*
Is this position being created as a result of response to a community need, a newly created position, or some other reason?*
Please provide any additional information, which would aid us in determining your eligibility to hire Work-Study students.*
Acknowledgment*
I certify the information provided above is accurate to the best of my knowledge.