ACTION COMMUNITY VOLUNTEER APPLICATION FORM First Name: Gender: Male Female Last Name: Address: City: Postal Code: Home Phone: Work Phone: What is the best time and place to reach you? What is your present occupation? Do you have needs relatd to accessibility? Check all that apply. Child Care Sign Interpretation Braille/Large Print Materials Bus Fare Cultural Interpretation Accessible Transportation Other How did you hear about the Action Community? Do you have specialized skills which you would like to offer? Do you have previous community/volunteer experience which you would like us to know of? What do you hope to gain and/or accomplish by being part of the Action Community? Availability for Action community volunteer work: Mornings: Mon. Tues. Wed. Thurs. Fri. Afternoons: Mon. Tues. Wed. Thurs. Fri. Evenings: Mon. Tues. Wed. Thurs. Fri. We ask that Action Community Volunteers make a 6 month commitment, is that possible for you? Yes No How many hours per month do you have to offer the Action Community? What type of work are you interested in? (Check as many as you like) Women Only: Child Care Reception Support Women and Men: Special Events
ACTION COMMUNITY VOLUNTEER APPLICATION FORM
Do you have needs relatd to accessibility? Check all that apply.
Child Care Sign Interpretation Braille/Large Print Materials Bus Fare
Cultural Interpretation Accessible Transportation
Other
Availability for Action community volunteer work:
What type of work are you interested in? (Check as many as you like)
Women Only: Child Care Reception Support
Women and Men: Special Events
