Volunteer Application

* required fields

Contact Information
*First Name
*Last Name
*Street Address
*City	,State	Zip
*Home Phone
Work Phone
Email Address

Availability
During which hours are you available for volunteer assignments?
Weekday Mornings	Weekend Mornings
Weekday Afternoons	Weekend Afternoons
Weekday Evenings	Weekend Evenings

Interests
Tell us in which areas you are interested in volunteering
Administration
Grant-writing/fundraising
Instructor Aide – Adult Computer classes
Homework tutor- youth programs
Develop a science or math activity for youth program
Provide job/career advice to high school teens
Work with youth on technology projects
Newsletter production
Volunteer recruitment and coordination
Technical Volunteer (provide technical support to users/computers)

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

Previous Volunteer Experience
Summarize your previous volunteer experience.

Person to Notify in Case of Emergency
Name
Street Address
City	,State	Zip
Home Phone
Work Phone
Email Address

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.

*Today's Date

Volunteer Application

Contact Information

Availability

Interests

Person to Notify in Case of Emergency

Agreement and Signature