volunteer form

for printable form (PDF), click here.

* required fields

First Name*
Last Name*
Street Address
City
State
Zip
Home Phone Number
Work or Cell Number
Email Address*

Volunteer Availability
Availability - hold down the CTRL key for mutiple selections


Area(s) of Interest
Please Tell us in which areas you are interested in volunteering - check as many as apply
	Administration Grant-writing/fundraising Instructor Aide – Adult Computer classes Homework Tutor - Youth programs Develop a science or math activity for youth program Work with youth on technology projects Newsletter production Volunteer recruitment and coordination Technical Volunteer (provide pc tech support to users)

Special Skills
Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities:

Prior Experience
Summarize your previous volunteer experience:

Emergency Contact
Name
Address
City, State
Phone Number
Relationship to you

Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. By signing below, I agree to sign an Authorization Form allowing a Criminal Background check and understand that this must be completed before I commence volunteer activities.
Your Name*
Today's Date*
Image Verification
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Volunteer Availability