Volunteer Application Date* MM slash DD slash YYYY Birth Date* MM slash DD slash YYYY Name* First Middle Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code How long at this address? PhoneCellEmail* Do you have computer access? Yes No Level Skill on computer: Beginner Intermediate Advance Physical limitations No Yes Please ExplainEducation (highest level) Middle School High School Some College College Graduate Are you presently enrolled in an accredited school? Yes No Name of School Class Level Graduate Degree Business Tech/Vocational Degree Present Employer/Occupation (former occupation if retired) Previous volunteer experience Did you enjoy this experience Yes No WhyWhy notList Skills and ExpertiseOther Languages Volunteer Availability. Number of Days per week 1 2 3 4 5 Days Monday Tuesday Wednsday Thursday Friday Saturday Sunday No Preference I am available to volunteer hours per WEEKHours per MONTHShort term projects only Yes No I am available year round Yes No Please check months January February March April May June July August September October Novemember December I prefer working with (check all that apply) Preschool children School age Teens Adults Families Seniors Men Women I prefer to work Indoors Outdoors No preference I prefer to work (check all that apply) Shelbyville Morristown Waldron Fairland Southwestern No preference What are your hobbies and interests?Are you requesting a specific assignment with one or more of the agencies? Boys Club Family Services & Prevention Program LifeLong Learning Pregnancy Care Center SCUFFY – Shelby County United Fund for You Shelbyville/Shelby County Public Library Shelby County Cancer Association Shelby Community Health Center Shelby County Players Shelby Senior Services Any other agency not listed Do you have transportation Yes No Non-family reference First Last PhoneNon-family reference First Last PhoneIn case of emergancy First Last PhoneRelationship to you Check yes if you agree with the terms.* Yes Shelby County Volunteer Alliance does not and will not discriminate against any person because of his or her gender, age, national origin, race, ancestry, income or religious affiliation. The information requested regarding emergency contact, references and experience is obtained to protect and best serve you and our clients. The application process is meant to be informal with the primary focus on gathering information about you so that the program coordinator can find the most suitable match for you as a volunteer. *Agencies may require additional information.By submitting this formI agree to serve any client who is assigned regardless of race, sex, creed, or national origin. I agree to a Criminal History check prior to any assignment being made. Prior to assignment at a specific agency, applicant will be provided with all stated requirements for that agency and must agree to abide by their requirements, rules, and codes of conduct for volunteers. Δ
