Personal Information
Adult Volunteer Applicatoin
Name
*
First Name
Last Name
Preferred name
*
Street Address
*
City
*
State
*
Zip Code
*
Phone Number
*
Email
*
Birth Date
*
-
Month
-
Day
Year
Birth Date
Do you have a prior connection to St. Ann's?
*
Yes
No
If yes, how have you been connected?
Colleen Holcomb, Volunteer Services Manager, will reach out to you to set up a meeting. How do you prefer to be contacted?
*
Phone
Email
If applying in connection to one of the following programs, please select the program:
Nazareth University Partners in Service Program
St. John Fisher Service Scholar or First Generation Scholar
University of Rochester BEI Club
Emergency Contact Information
Emergency Contact Full Name
*
First Name
Last Name
Relationship
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Email
*
Personal Reference
Please provide a person who knows you well. Could be a friend, colleague, supervisor, teacher, coach, etc. Reference should not be yourself or a family member.
Name
*
First Name
Last Name
Relationship
*
Phone Number
*
Email
*
example@example.com
Interests & Background
Skills, hobbies, and special interests
*
Education
*
Special Courses
Previous work as a volunteer
Back
Next
Location to volunteer at
Select all locations you are open to volunteering at
Location
*
Irondequoit Campus
Webster Campus (Cherry Ridge)
Adult Day Services (Durand location on Culver Rd)
Adult Day Service (Home Connection at Portland Ave)
Wherever I'm needed most
Availability & Hours
NOTE: *All volunteers must complete a minimum of 20 volunteer hours over a flexible time period*
I confirm I can volunteer for a minimum of 20 hours
*
YES
NO
What days of the week are you able to volunteer? (Select all that apply)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What time of day are you able to volunteer?
*
Mornings
Afternoons
Evenings
Are these required service hours?
*
Yes
No
If yes, how many hours are needed?
When do these hours need to be completed by?
What are the hours required for?
Back
Next
Signatures
By entering name and date below, you are verifying that all information entered above is true and accurate
Volunteer Signature
*
Today's Date
*
-
Month
-
Day
Year
Date
Please verify that you are human
*
Submit
Should be Empty: