UR SUCCESS Placement Partner Application

Placement Partner Application


I am an employer who is interested in partnering with UR SUCCESS to place a student in my business.

	Name of Company A value is required.
	Address
	City	State	Zip

	Contact
	Name A value is required.
	Business Phone A value is required.Invalid format.	A value is required.Invalid format.Cell Phone Invalid format.
	E-mail A value is required.Invalid format.

	Mailing Address (if different than above)
	Address
	City	State	Zip

	How Did You Hear About UR SUCCESS?


	Description of Business


	Description of Internship/ Employment Position


	Estimated Hours/week	Number of Positions Available
	Estimated Number of Weeks	Start Date A value is required.Invalid format.
	The position is Paid Unpaid

	Specific Job Qualifications/Requirements


	Why do you want to have a student placed in your business?

UR SUCCESS, 1631 NE Broadway St., PMB 352, Portland, OR 97232, 971 340-5577, info@ursuccess.org
For web-related issues, contact webmaster@ursuccess.org