Volunteer Application

The Volunteer Program was established to provide additional support to individuals, provide additional resources to the agency, and foster community relations. The program would determine consumer needs by use of a survey, develop supporting documentation, recruit and train volunteers, and monitor the effectiveness of the program.

Date
Date Format: MM slash DD slash YYYY
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email*
Birthdate*
Have you been convicted of a felony?*
- Yes
- No
If yes, explain*

Reference #1
Please list three individuals you have known for at least one year.
Name*
First Last
Address
Street Address City State ZIP Code
Phone*
Reference #2
Please list three individuals you have known for at least one year.
Name*
First Last
Address
Street Address City State ZIP Code
Phone*
Reference #3
Please list three individuals you have known for at least one year.
Name*
First Last
Address
Street Address City State ZIP Code
Phone*
I certify that the facts contained in this application are true and complete to the best of my knowledge and understanding. I authorize the investigation of all statements contained herein and give permission for the references listed above to give you any and all information concerning my background, and release all parties from all liability for any damage that may result from furnishing the same to you. Click here if you have read and understand the Volunteer Statement.*
- I have read and understand the Volunteer Statement

Step 1 of 3

Education

Reference #1

Reference #2

Reference #3