Volunteer Application


* - Required Fields

I'm interested in volunteering for:*
Chapter Administration
connect2culture®
Health Fairs, Street Fairs, Agency Fairs
Bi-Lingual Volunteer
Special Events
Walk Committee
Junior Committee

First Name*
Last Name*
Address*
City*
State*
Zip*
Phone*
Email*
Birthdate (e.g. 2/05/1980)

Current/Most Recent Employer
Does your employer provide matching gifts? Yes No

Students: School & Adviser:
Education/Degrees/Certifications:
Special Skills/Talent/Hobbies/Interests:*
Language(s) spoken:*
Computer Experience/Typing Skills/Level of Proficiency:*
What prompts your interest in Us?*
Family Member
Professional
Caregiver
Concerned Friend
Other

Are you a caregiver at this time? Yes No

How did you hear about Us?
Why do you want to volunteer for Us?*
When can you start?*
How long can you commit to volunteering?*
Fewer than 6 Months 6-9 Months 1 Year 1+ Years

Days/Hours of availability

Days
Monday Tuesday Wednesday Thursday Friday
Saturday Sunday

Evenings
Monday Tuesday Wednesday Thursday Friday
Saturday Sunday

Weekends
Monday Tuesday Wednesday Thursday Friday
Saturday Sunday

References

(Please provide two references with current phone numbers and their relationship to you)*
Other Civic/Volunteer Experiences
(Please list Name of Organization(s), Capacity Served, Number of Years)
Other Community Affiliations (Churches, Clubs, Activities):

Emergency Contact Information

Name*
Relationship*
Phone*

Accept Terms & Policy

I certify the information given above is true and complete to the best of my knowledge.  I authorize CaringKind to contact the places and persons listed as references.
I Accept*