EMPLOYEE INFORMATION

Employee name:

Division:

Organization information

Organization:

Address:

Website:

Describe the organization’s mission and who it serves:

Describe the service(s) you will provide to the organization:

Explain how providing these services to this organization will meet the following outreach and equity goals:

1.  Advancing the Auditor’s Office’s equity and outreach goals by building relationships with community-based organizations.

2.  Raising community awareness about the services and information available from the Auditor’s Office, with a focus on historically underserved communities.

3.  Providing services that enhance and serve the communities in the Portland area.

Employee certification: I have confirmed that the organization needs and/or wants my assistance: o YES

Does this organization receive funding from the City of Portland, a City Bureau or Prosper Portland? o YES o NO

Date(s) and time(s) of planned volunteer work:

Total number of hours requested:

Employee certification: I have read and understand Auditor’s Office Administrative Rule 3.17: o YES

Employee signature:

SUPERVISOR AND AUDITOR APPROVAL

Supervisor signature:

City Auditor signature: