Volunteer Application

Name:

Address:

City:

State:

Zip:

Daytime Phone:

Evening Phone:

Email Address:

Age (exact age only if under 18):
Under 18:
18-20 21-30 31-45
46-64 65+

Occupation/Work Experience:

Place of Employment:

Employer Phone Number:

Educational experience:

Church home:

Pastor:

Church/Pastor Phone:

Languages spoken:

Prefer to work with:

No preference	Preschool	Elementary	Middle school
High school	Young adults	Adults	Seniors (60 +)

Time available to volunteer (please state hours)

Skills that I have and would like to share are:

My volunteer experience includes:

All volunteers are required to submit to a criminal background check or provide one that is less than six months old.