501 (c) 3 Non-profit
Organization Application
(Copy to FAX or print)
Name of Agency: ____________________________________
Mailing Address: ____________________________________
City, Syate, Zip: _____________________________________
Contact Person: _____________________________________
Volunteer Job Title: __________________________________
Expected Duties:
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Qualifications Needed:
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Special Requirements:
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Agency will accept: ( ) Court Referral ( ) R.S.V.P. ( )
Handicapped ( ) Teens ____________________
Acceptable Age Range
Report to: __________________________________________________________________________
Location: ___________________________________________________________________________
Dates Needed: ___/___/___ to ___/___/___
Total Hours: ____ AM/PM - ____ AM/PM
Length of Time: ( ) Short Time ( ) Ongoing
Agency Provides: ( ) Orientation ( ) Training
Reimbursement: ( ) Mileage ( ) Meals
Close To: ( ) Bus Line ( ) Other
Comments:
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