Volunteer Application Form

Your Name *

First Name Last Name

Gender

Male Female

Your Email *

example@example.com

Your Cell Phone Number *

Area Code Phone Number

Birth Date *

Date

Education Level *

School Name *

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home City and State

Emergency Contacts *

Availability Information *

	From (time)	To
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays

Why do you wish to be a volunteer in this program? *

At most two sentences.

Please state your other volunteering experiences. *

Do you have any special certifications, knowledge, experience? (e.g. Special Needs, AP Level Classes)

Yes No

What are other interests or skills that we should know about? *

If yes, explain

Areas of Service

Academic Tutoring Mentoring Performing Arts (drama, dance, music) Event Planning Counseling Fundraising Life Management and Career Preparation Parent Education

Age of Youth that You Prefer to Assist

Elementary Middle School High School No preference

Have you been vaccinated for COVID-19?

Yes, received both vaccinations Yes, received one vaccination and the other is scheduled No

Do you have transportation?

Yes No

Do you have any criminal convictions?

Yes No

If yes, explain.

I hereby acknowledge that the information given above is accurate and I do not have any disease or medical condition that prevents my participation in the activities.

Volunteer Candidate Signature *

Clear