2025 EmergeServes Application

Are you currently an active EMERGE member?

YesNo
Name

First NameLast Name
Name (preference)
Present Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone

Area CodePhone Number
Mobile Phone

Area CodePhone Number
Email
example@example.com
Position Held
How Long Have You Worked for Your Employer?
COMMUNITY/ORGANIZATION/ACTIVITY INFORMATION
Please list the Organization Name, Position Held and the dates in the box below. List community/business/professional organizations and activities in which you have participated. (Including academic, not limited to Lakeland):
Why are you most interested in participating in EMERGE Serves?
AREAS OF INTEREST

AnimalsEnvironmental/GreenLiteracy/EducationArtsFaith BasedPoliticalChamber of CommerceGovernment/VisioningSenior Citizens/VeteransChildren/Youth ServicesHealth & WellnessUnited WayDevelopmental DisabilitiesHomelessnessOther(detail below)
Anything else you would like to share?
I understand that the EMERGE Serves program will be held each of the following Tuesdays: August 19, 2025 @ COhatch // 4:30-7:00 pm, August 26, 2025 @ COhatch // 4:30-7:00 pm, September 2, 2025 @ COhatch // 4:30-7:00 pm, September 9, 2025 @ COhatch // 4:30-7:00 pm, September 16, 2025 @ COhatch // 4:30-7:00 pm, and September 23, 2025 @ First Presbyterian Church // 4:30-8:00 pm. Attendance at ALL sessions is mandatory for graduation from the program. The community leaders have been gracious enough to carve out their time to be with each of you, so it is important that you be here each night. By signing below, you indicate that you can devote this time to the program. I authorize EMERGE Lakeland, The United Way of Central Florida, and The Lakeland Chamber of Commerce to share my information with agencies and organizations that match my community service areas of interest.
Applicant's Signature and Date:

Clear
All Applications must be received by August 1, 2025, to be considered.
Should be Empty: