OFA - Federal Work-Study Off-Campus Employer Questionnaire

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501(c)(3) Designated Non-Profit Agencies that are headquartered in the State of Michigan should use this application to become an Off-Campus Work-Study employer for University of Mchigan Ann-Arbor students.

Complete Name of Agency

Agency Address (Street, City, State, ZIP)

Agency Telephone Number

Agency Email Address

Name of Executive Officer

Title of Executive Officer

Is your agency incorporated as a non-profit agency or institution?

If Yes, attach documentation of 501(c)(3) exempt status, i.e. IRS Determination Letter.

Yes No

Source of Agency Control

Public Private

Source of Agency Funding

What is the purpose/mission of your agency?

What are the general functions of your agency?

Number of full time employees:

Number of part time employees:

Number of students employed by agency:

This number should not include those employed through the work-study program.

Have there been any changes in the size of your agency's staff in the last year?

Yes No

Please explain the changes in the size of your agency's staff.

What type of work will work-study student(s) perform?

How many work-study students are you interested in hiring?

What criteria are used to establish the appropriate pay rate for part-time employees? How do these wages relate to those of full-time employees?

Is anyone at your agency (who is not a UM-Ann Arbor student) affiliated with the UM-Ann Arbor campus?

Eg. Board Member, Employee, etc.

Yes No

Name of Personnel Director

Provide the name of the personnel director or the agency representative who should be contacted regarding employment matters.

Title of Personnel Director

Personnel Director Email

Personnel Director Telephone

Attachment

Provide the document or spreadhseet associated with this request.

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Other Fields

Your name

Your email address

Verification Code