LP YMCA Volunteer Application

1
Name* This field is required.
First Name
Last Name
2
Email
example@example.com
3
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
How long have you been at your current address?* This field is required.
5
Phone Number* This field is required.
Please enter a valid phone number.
6
Are you 18 years of age or over?If no, please have your parent or guardian sign the application, too
YESNO
7
Emergency Contact* This field is required.
Emergency Contact Full Name
Emergency Contact Full Address (Street address, city, state, and ZIP)
Emergency Contact Phone Number
8
How did you learn about volunteer opportunities at the YMCA? * This field is required.
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Ok
9
Why would you like to volunteer?* This field is required.
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10
Have you heard about any particular volunteer opportunities that interest you? * This field is required.
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11
Would you like to talk to someone further about what kinds of volunteer opportunities might match your skills, talents, and interests? * This field is required.
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Ok
12
Are there any particular skills, talents, or interests you'd like to share? * This field is required.
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13
Are there any particular skills, talents, or interests you'd like to share?
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14
Are there any particular skills, talents, or interests you'd like to share?
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15
Are you a member of the YMCAMembership is not required
YESNO
16
Past ResidencesPlease list your last two addresses (excluding your current address) starting with the most recent:
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17
Employment History* This field is required.Starting with the most Recent. Type the information and click "Add Employer" when finished.
18
What is the furthest degree of education you have completed?* This field is required.
Please Select
Please Select
High School
College
Trade or Business
Other
19
Describe your eductationElaborate as needed about school choice, course of study, education start and end dates, graduation, and diplomas.
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20
Other SkillsCaring for children, languages, etc.
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21
List any names you may have used in the past
22
Driver's License Number
23
Driver's License Classification
24
Have you ever been convicted of a criminal offense?If so, what was it? (The La Porte County Family YMCA conducts background checks on volunteers)
25
References* This field is required.Please list three references. Include name, address, phone number, and relationship to you.
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26
AffiliationsPlease list the names of relatives, friends, or acquaintances employed by the YMCA and their relationship to you.
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27
Signature
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