Volunteer Application Form for Non-Profit

Volunteer Information

Please complete the following information
Section 55.9 of the Home-Delivered Meals Handbook by the Texas Health and Human Services Commission requires a provider agency to maintain documention to show that volunteers meet requirements and agree to follow guidelines outlined in subsections (a)-(c) of Section 55.9.
Name*

PrefixFirst NameLast Name
Birth Date*

MonthDayYear
Email
example@example.com
Phone Number*

Area CodePhone Number
Second Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact*

First NameLast Name
Phone Number*

Area CodePhone Number
Name of organization you represent as a driver:
Do you speak anything other than English?
I would like to be a

Substitute DriverPermanent DriverEmergency Driver
Select your available days
I am available to pick up meals after 10:30 AM and before 11:00 AM for delivery.*
I am over 18 years of age or will be supervised by a volunteer who is at least 18 years old.*
Date

MonthDayYear
Date
My signature below provides written authorization to Hale County Meals on Wheels to obtain background checks (DPS, NAR, EMR) on my behalf as required by the Texas Heatlh and Human Services Commission (Section 49.304)
Signature
Should be Empty:

Volunteer Information