LCEC Volunteer Application

Applicant Information
Name*

First NameMiddle NameLast Name
Please list any other names you have gone by:
Pronouns

She/Her/HersThey/Them/TheirsHe/Him/HisOther
If you are volunteering with a group, please write the organization's name here:
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you 18 years old or older?*

YesNo, I am 17 or younger
Youth Volunteer Policy

Youth under 15 years old are required to volunteer with an adult, and will be able to participate in volunteer opportunities that are appropriate for their age.

References

Please share with us the names and contact information of two people who can serve as a reference for your ability to work successfully as a volunteer for the LCEC. Your references cannot be immediate family members or a current or previous member of the LCEC staff. Before a volunteer can serve, both teens and adults must have TWO completed references.
Primary Reference Full Name*

First NameLast Name
Primary Reference Email*
example@example.com
Primary Reference Phone*
Please enter a valid phone number.
Secondary Reference Full Name*

First NameLast Name
Secondary Reference Email*
example@example.com
Secondary Reference Phone*
Please enter a valid phone number.

Consent to Background Check

At LCEC, one of our goals is to provide a safe and healthy atmosphere for all visitors to our Center, particularly youth. Because of our commitment to program safety and quality, we ask all LCEC volunteers to complete this background check form.
Date of Birth*

MonthDayYear
Date
What is your race?*
What is your gender?*
What was your sex assigned at birth?*

FemaleMale
Have you lived outside of the state of Wisconsin in the last 5 years?*

YesNo
Do you give permission to the Lussier Community Education Center to complete your background check?*

YesNo
Please list anything we will find on your background check here. Note: Having something on your background check does not automatically disqualify a person from volunteering. The main obstacle that prevents someone from volunteering is not disclosing this information in advance.
Should be Empty:

Applicant Information