Parish/School Name: blanks Location: blank
Please indicate if you are: blanks A current employee or volunteer for this parish or school. blank What position?
Please specify your parish/school. If not a member of a parish, or associated with a school, please leave blank: blanks Parish/School. blank City
Volunteer history should include 5 of your most recent activities. If you are still participating in a volunteer program, then indicate “to” date as current.
Start with most recent dates
If Yes: When blanks Where blank
Please read and mark the checkbox next to each of the statements below:
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Digital Signature*