* Required Fields
*Name
*Street 1
Street 2
*City
*State
*Zip
*Home Phone
Work Phone
Cell Phone
Fax Number
* Email
Health Limitations
*Relationship
Work or Cell Phone
Email
Tell us in which areas you are interested in volunteering
Peer Support
PR/Outreach
Office Support
Library
Fund Raising
Special Events
Other
Summarize special skills and qualifications, including your educational background.
Summarize your previous volunteer experience.
During which hours are you available for volunteer assignments?
Are you currently employed?
Full-Time Part-Time
Work Experience.
Please list 3 references: 2 employment, academic, volunteer, church or community involvement references & 1 personal, non-family member reference.
(References are contacted first by phone, then if no response, a second attempt is made via email.)
Reference 1
*Phone
Reference 2
Reference 3
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
*I agree to the above statement
It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual orientation, age, or disability.
Thank you for completing this application form and for your interest in volunteering with us.
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