Neighborhood House: Volunteer Enrollment Form

Volunteer Enrollment Form

* indicates a required field

*	Salutation:
*	First Name:
*	Last Name:
	Address:
	City:
	Zip:
	Tel (home):
	Tel (work):
	Tel (cell):
*	E-mail Address:
	Emergency Contact:
	Tel:
	Add me to your mailing list: Yes No

I. Skills and Interests

Highest Level of Education:

Major Field of Study:

Current Occupation
(or previous work experience):

Hobbies, Interests, Skills:

Previous Volunteer Experience:

Do you speak any other languages?
Please list.

What type of position are you interested in? Volunteer Intern Work Study

Why are you interested in volunteering with Neighborhood House? Please indicate if it is for a school requirement or court ordered community service.

Is there a particular type of volunteer work in which you are interested? (check all that apply)

Marketing
Tutoring/Mentoring youth
Fundraising
General administrative duties

Classroom/Assistant
Special Events Committee
Board Committee
No Preference

MIS/Web Design
Transportation
Reporter/Photographer/Editor

Other:

Is there a person or group with whom you are particularly interested in working?
(check all that apply)

Adults
Agency Staff

Seniors
No Preference

Teens (ages 13-18)
Children (ages 4-12)

Other:

Are there any groups you would not feel comfortable working with?

No Yes Please explain:

Aside from your regular volunteer placement, would you be willing to help with special projects (i.e. mailings, events)?

In the office At home At community events

II. Availability

I am available: Mornings Afternoons Evenings Weekends (special events)
Days of the week I am available are:
I would like to serve for: three months six months Other:

III. References

List the names and phone numbers of two references:
Name:		Tel:
Relationship:

Name:		Tel:
Relationship:

Have you been convicted of any criminal activity in the past 7 years?
No Yes
If yes, please explain (this does not automatically exclude you from volunteering):

IV. Demographics (optional)

Neighborhood House requests the following information for statistical purposes only.

Sex:

Male Female Birth Date (mm/dd/yy):

Ethnicity:

American Indian Caucasian Not Known	African American Hispanic/Latino Multi-racial	Asian/Pacific Islander Middle Eastern
Other:

How did you hear about Neighborhood House?

Friend
Work
Radio

TV
Other agency
School

Newspaper
Online

Other:


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