Volunteer Application
(Copy to FAX or print)
Title: Dr. / Mr. / Mrs. / Miss / Ms.
Name: ____________________________________
Home Address: _____________________________
City: ______________________________________
Business Address: __________________________
City, State, Zip: _____________________________
Transportation: ( ) Own Car ( ) Shared Rise ( ) Bus ( ) None
Days of the Week Available: __________________
Hours of the Day Available: ___________________
How can you best be reached? Daytime phone: _____________________
Evening phone: _____________________
Interests and Skills:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Your Age? Check one: Under 25 ___ 25-34 ___ 35-44 ___ 45-54 ___ 55-64 ___ Over 65 ___
Age you prefer to work with? Check one:
No Preference ___ Pre-School ___ Elementary School ___
Teen ___ Adults (Under 65) ___ Adults (Over 65) ___
Source of Contact? Check one:
TV ___ Radio ___ Newspaper ___ Website ___ Friend ___ Other ___