Meals on Wheels East Texas Volunteer Application

VOLUNTEER APPLICATION

Thank you for applying to serve with us!
Site Information
Which Meals On Wheels East Texas location (city) do you want to volunteer with? As a reminder, we serve the following counties in East Texas: Gregg, Henderson, Smith, Upshur, Van Zandt, and Wood.*
Tyler, Tx
Basic Information

Volunteer Application to be completed by Applicant.
Name*

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Email Address*
example@example.com
Home Address
City*
State*
Zip Code*
Cell Phone
Enter your call phone number here.
Alternate Phone
Enter an alternate phone number here.
How do you want us to contact you?*
Please Select One
How did you hear about becoming a Meals on Wheels volunteer?*
Friend, social media platform, news source, flyer, etc.
Will you be volunteering through or on behalf of an employer, church, school, or other organization?*
Name of Organization
Emergency Contacts

Who would you like us to contact in case of emergency? Include at least one; two is preferable.
Name of Emergency Contact*
Daytime Phone*
Enter your emergency contact's daytime phone number here.
Relationship*
Name of Emergency Contact*
Daytime Phone*
Enter your emergency contact's daytime phone number here.
Relationship*
Sign and Submit

Use your mouse (or finger if you have a touch screen) to sign. Then date your form and click the "submit" button at the bottom of the page.
Signature Disclaimer - to be completed by volunteer applicant.

For the protection of our clients, staff, and volunteers, we are required by state statute to complete a volunteer status check. By your signature, you are consenting to allow Meals on Wheels East Texas to complete this volunteer status check through the Department of Public Safety Criminal History Conviction database as well as the Texas Department of Aging and Disability Services specific to the Nurses' Aide Registry/Employee Misconduct Registry as required by Health and Human Services. We appreciate your understanding, and we thank you for applying to volunteer for Meals on Wheels East Texas!
Signature*

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Date*

MonthDayYear
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VOLUNTEER APPLICATION

Site Information

Basic Information

Emergency Contacts

Sign and Submit