Volunteer Application

Volunteer Application
Thank you for your interest in volunteering at Cancer Support Community Pasadena! Please take a moment to complete this application, and a staff member will be in touch with you within a business day.
Name

First Name Last Name
Date

Month Day Year
Date
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Date of Birth

Month Day Year
Date
Email
example@example.com
Emergency Contact Name
Emergency Contact Phone Number
Have you ever been convicted of a crime?

Yes No
If yes, please explain:
How did you learn about Cancer Support Community?
Have you had cancer?

Yes No
Do you wish to receive our monthly calendar via email?

Yes No
Do you wish to receive information about donating to CSCP and invitations to fundraising events?

Yes No
Place of Employment (or previous career if not working):
Please list any professional credentials:
Have you ever volunteered before?

Yes No
If yes, with which organizations and for how long?
I am interested in volunteering:

Weekly Monthly On an as needed basis
I am available (select all that apply)

Mondays Tuesdays Wednesdays Thursdays Fridays Weekends
Is it necessary to limit your physical activity?

Yes No
If yes, please explain:
Please indicate the languages that you speak fluently below:
Skills checklist (select all that apply):

Social Media Clerical Computer Teaching Marketing Phone Calls Professional Writing Graphic Design Public Speaking Other
Which volunteer opportunities interest you (select all that apply)?

Program Support (instructor/ presenter) Office Support Outreach Special Events Calendar Delivery Front desk support
Confidentiality Agreement

I agree to keep confidential all information that comes to my attention whether directly or indirectly concerning community members or any member from the staff, Board of Directors, or Professional Advisory Board. I agree not to divulge any such information to anyone. I fully understand this policy and agree to adhere to it at all times and comply with all oral and written directives of Cancer Support Community Pasadena personnel. If I do not adhere to this policy, I understand it is grounds for removal from my volunteer position.
Signature

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