Contact Information

Name:-

Street Address:-

City ST ZIP Code:-

Home Phone:-

Work Phone:-

E-Mail Address:-

Availability-

Date of Brith-

s.s Number-

During which hours are you available for volunteer assignments?

___ Weekday mornings

___ Weekend mornings

___ Weekday afternoons

___ Weekend Afternoons

___ Weekday evenings

___ Weekend evenings

Interests

Tell us in which areas you are interested in volunteering

___ Administration

___ Events

___ Fieldwork

___ Fundraising

___ Deliveries

___ Phonebank

___ Newsletter production

___ Volunteer coordination

Special Skills or Qualifications

Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.

Previous Volunteer Experience

Summarize your previous volunteer experience.

Person to Notify in Case of Emergency

Name

Street Address

City ST ZIP Code

Home Phone

Work Phone

E-Mail Address

Agreement and Signature

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.

Name (printed)

Signature

Date

Our Policy

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Thank you for completing this application form and for your interest in volunteering with our ministry.  We look forward to working with you.