Volunteer Interests (please choose all areas that you would be interested in): Sibship 11:00am-3:00pm last Sat monthly Group Respite 6-8pm Fridays 12:30-4:30pm Saturdays Events/Other Camp Programming during school breaks After School Program MTuWF 3:00-6:00pm Th 2:00-6:00pm Daycare 0-5 years Reason for Volunteering Work School Fraternity/ Sorority Job Interest Community Service Other Applicant Information Applicant's Name (required) Address (required) City (required) State (required) Zip (required) Email (required) Phone # (required) Are you 18 years or older? YesNo Do you have a health related condition that may interfere with your ability to safety and effectively perform any duties of the position for which you are applying? YesNo If yes, please explain: Have you ever been known by any other name(s)? YesNo If yes, please indicate the name(s): Have you ever been convicted of a felony? YesNo Have you ever had a founded case of child or dependent adult abuse? YesNo
