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
Personal Reference
Name
*
First Name
Last Name
Relationship
*
Phone Number
*
Email
*
example@example.com
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
*
Location to volunteer at
Select all that apply
Location
*
Irondequoit Campus
Webster Campus (Cherry Ridge)
Durand Adult Day Services
Portland Home Connection (Adult Day)
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?
Education
Education
*
Special Courses
Skills, hobbies, and special interests
*
Previous work as a volunteer
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
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