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Volunteer Application

Please fill out the form below and it will be directly emailed to us.

Your Name:
Address:
City/State/Zip:
Home Phone:
Work Phone:
Your Email:

May we contact you at work?	Yes No
When is the best time to contact you?
Referred by:
Name you wish to be called by such as Patricia, Pat, Patty, etc.

EMERGENCY INFORMATION:
Name:
Relationship:
Day Phone:

LIFE EXPERIENCES

We attempt to schedule our volunteers to meet their schedule needs, as well as our openings. Most schedules are done on a half-day basis. Some people volunteer one time per month; other volunteer several times per week. A few volunteers are "on call" or have a flexible schedule. In order for us to plan for your placement, please list the times that you would be available to volunteer and the frequency with which you would like to volunteer:

How often would you like to work?
(Check all that apply)
Weekly
Monthly
Semi-monthly
Other:

What day(s) of the week would be best for you?
(Check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

What time of day would be best for you?
(Check all that apply)
Mornings
Afternoons
Evenings

Volunteer Objectives
(Check all that apply)
learn new skills
enhance personal growth
have fun & relax
meet & work with other people
use current skills
explore careers
make worthwhile use of time
do something nice for others
Other

REFERENCES:
Name:
Relationship:
Phone:
Full address:

Name:
Relationship:
Phone:
Full address:

Name:
Relationship:
Phone:
Full address:

I hearby certify that the information provided on this form is true and complete to the best of my knowledge
Today's Date: