Volunteer Form

Personal Information:

First Name(Required)

Surname(Required)

Email(Required)

Phone(Required)

Address

City

State

Zip Code

Employer or University (Currently Enrolled in) Name:

If yes, please explain:

Emergency Contact Information:

Person to contact in case of emergency.

Name:(Required)

Relationship to you:(Required)

Primary phone no:(Required)

Secondary phone no:(Required)

Personal and/or Professional References

We require at least 2 reference records to be on file before you can be placed into a volunteer position. Please provide references who know you and are NOT relatives. These records will be kept confidential.

Reference 1:

Name:(Required)

Email:(Required)

Phone:(Required)

How long have you known this person:(Required)

Relationship:(Required)

Reference 2:

Name:(Required)

Email:(Required)

How long have you known this person:(Required)

Relationship:(Required)

Volunteer Preferences

Check all that interest you

Special Skills/Interests:

Start Date

End Date

Tell Us About Yourself

Providing this information is optional but is extremely helpful to us.

Birthdate:

Religious Affiliation:

House of Worship:

Reason for Involvement:

If yes, how many hours, for what class, and what are your requirements for the class?:

Statement of Veracity and Acknowledgement

I hereby clarify that the facts set forth in the above application are true and complete to the best of my knowledge. I understand that completing this application does not ensure a volunteer placement. I also understand that this is not an application for paid employment.

Applicant’s Signature: (type full name)(Required)

Date:(Required)

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Volunteer Form

Personal Information:

Emergency Contact Information:

Personal and/or Professional References

Reference 1:

Reference 2:

Volunteer Preferences

Tell Us About Yourself

Statement of Veracity and Acknowledgement

Group Information:

Group Information: