Volunteer Application Form

First Name (required) Last Name
Address
City Zip Code
Home Phone Mobile Phone
Email Address
Personal Reference Reference Phone
Emergency Contact Name Emergency Contact Phone
Date available to begin Are you over 21?
Preferred Time
Monday to
Tuesday to
Wednesday to
Thursday to
Friday to
Saturday to
Sunday to
Are you interested in becoming a long term volunteer?
Which volunteer opportunity are you interested in?
Why do you want to volunteer at the Child Abuse Prevention Center?
Previous volunteer experience
List any special skills, language abilities, talents and/or interests that might be valuable to your service.
Languages spoken
Are you able to perform the essential functions of the position for which you are volunteering,
either with or without reasonable accommodations?
Have you ever been convicted for a crime other than a traffic violation?
(Note: A failure to answer truthfully will adversely impact your ability to volunteer at the Child Abuse Prevention Center)
If yes, please explain:
Questions or comments
Students
Are you at least 18 years of age?
Which school do you attend?
Will you receive academic credit for your volunteer work?