Volunteer Application

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

Name

First NameLast Name

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date of Birth

Date

Email

example@example.com

Emergency Contact Name

Emergency Contact Phone Number

Have you ever been convicted of a crime?

If yes, please explain:

How did you learn about Cancer Support Community?

Have you had cancer?

Do you wish to receive our monthly calendar via email?

Do you wish to receive information about donating to CSC and invitations to fundraising events?

Place of Employment (or previous career if not working):

Please list any professional credentials:

Have you ever volunteered before?

If yes, with which organizations and for how long?

I am interested in volunteering:

I am available (select all that apply)

Is it necessary to limit your physical activity?

If yes, please explain:

Please indicate the languages that you speak fluently below:

Skills checklist (select all that apply):

Which volunteer opportunities interest you (select all that apply)?

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 San Gabriel Valley personnel. If I do not adhere to this policy, I understand it is grounds for removal from my volunteer position.

Signature