Date:_____________________
Name:___________________________________________ Day
phone:________________________
Address:_________________________________________ Eve. phone:________________________
City:__________________________________ State:________________ Zip:____________________
Education level: 10 11 12 College
1 2 3 4 (circle highest level completed)
Previous volunteer experience:
__________________________________________________________________________________
Times available:______________________________________________________________________
What kind of volunteer work would you like to do at CHOICE, unlimited?
____________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________
Have you ever worked or volunteered for CHOICE, unlimited? Yes / No
If so, when and what did you do?_______________________________________________________
Where do you work/study now?________________________________ Hours per week:___________
Please list any special training / skills / interests:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
How did you hear about CHOICE, unlimited's volunteer opportunities?
__________________________________________________________________________________
Emergency Contact:_______________________________________
Phone:______________________
Relationship:_____________________________________________
Please list three references:
1)_____________________________ Phone:______________________
2)_____________________________ Phone:______________________
3)_____________________________ Phone:______________________