VOLUNTEER REGISTRATION FORM

The information on this form will help us find the most satisfying and appropriate volunteer assignment for you. Your cooperation in completing this form will aid us to keep accurate statistics for our records. Thank you for taking the time to fill out this form.

All fields MUST be filled in. Simply type in "N/A" if an item does not apply to you.

Full Name:
Date of Birth (xx/xx/yyyy format):   Age:   Sex: F M
Race: AFA ASI CAU HISP NatAm OTHER
Home Address:   Apt. No:
City:   State:   Zip:
Employer:
Job Duties:

Home Phone:   Work Phone: Ext:
E-mail:
Education: (Check last year completed) 5 6 7 8 9 10 11 12 GED
Post High School Education (check one): Vocational/Technical Bachelor's Master's PhD
Adult Continuing Education Other  Specify:
Field of Education:
Time available for Volunteer Work:
Church Member at:
Previous or Present Volunteer Experience:

Previous Work Experience:

Do you own a car? Yes No  If yes, list insurance limits:
Please list any physical restrictions you may have:

How did you hear about Voluntary Action Center?

Please choose from the following skills you would like to use in volunteer work:

Administration/Management/Leadership
Animals
Clerical
Education
Financial
Physical/Mental Health
Technical/IT
Advocacy
Arts/Music
Construction/Maintenance
Environmental
Library/Research
Special Events
Writing

Please describe any specific interests or comments regarding volunteer work: