The Arc of Chemung-Schuyler's Volunteer Application

Volunteer Application

At The Arc of Chemung-Schuyler, we are constantly looking for talented, dynamic people who want to make a difference in the lives of the people we support, and in their own lives, by giving their time, talent, and resources.
What brings you to seeking a volunteer opportunity with The Arc of Chemung-Schuyler?
Astericked (*) fields are required. After submission, you will receive a confirmation email and a follow-up email about your volunteer assignment and next steps.
CONTACT INFORMATION
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Cell Phone

Area Code Phone Number
E-mail *
Emergency Contact *
Name and Number
STATISTICAL INFORMATION
Gender *
Date of Birth *

Month Day Year
Date
What is the highest level of education completed? *
Have you ever been convicted of a misdemeanor or felony in any jurisdiction? *
Do you have any criminal charges pending against you? *
Please note: we cannot accommodate requests for Court Mandated Community Service.
VOLUNTEER PREFERENCES
How did you hear about volunteer opportunities at The Arc of Chemung-Schuyler?
Where you referred by an organization or colleague/friend?
I am available to volunteer beginning on *

Month Day Year
Date
and ending on

Month Day Year
Date

What days and or times are you available to volunteer? *

	Morning	Afternoon	Evening
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

List any special skills or qualifications which you feel would be beneficial as a volunteer for our organization:
REFERENCES

Please list three references. If you are under the age of 18, you must provide at least one school related reference.
Name
Phone or Email Address
Relationship to You?
Name
Phone or Email Address
Relationship to You?
Name
Phone or Email Address
Relationship to You?
IF INTERNSHIP OR COMMUNITY SERVICE
What school is requiring this internship/community service?
Who is your contact advisor for this internship/community service?
Phone number for your advisor?

Area Code Phone Number
E-mail for your advisor?
example@example.com
Number of hours you need to complete?
Date your hours needed to be completed by?

Month Day Year
Date
EMAIL PREFERENCES

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.
What kinds of email would you like to receive?

Electronic newsletters Volunteer recruitment appeals Schedule reminders Info about special events/fundraisers
VOLUNTEER AGREEMENT
Please mark to acknowledge that you agree to each of the following: *

I understand that all information and data about clients, agencies, volunteers, staff, and donors of The Arc of Chemung-Schuyler is strictly confidential and may not be discussed outside the office, or with any unauthorized person. I grant full permission to The Arc of Chemung-Schuyler to use any photographs, film, video or audiotapes of my performing volunteer work for any purpose The Arc of Chemung-Schuyler deems appropriate. I grant full permission to The Arc of Chemung-Schuyler to conduct a NYS-required Medicaid Exclusion Background Check prior to volunteering.
Should be Empty: