Volunteer Application

Please provide the following contact information:

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
SS #
Work Phone
Home Phone
FAX
E-mail

Which office would you prefer working at?

Main, Port Huron
Bad Axe
Sandusky
Lapeer
Caro

What activities would you be interested in? Check all that apply

Fundraising         Publications        Office Assistant       
Light Housekeeping  Recreation          Computers           
Advocacy            Housing             Accessibility 
Driver
(Insurance company)
(Drivers license #)

Other

List any volunteer and/or work experience:

List your special skills/hobbies/interests:

Do you have available transportation?

Yes No

Would you need any accommodations to complete volunteer projects?

Yes No

If yes, please explain:

What times are you available?  Mornings   Afternoons    Evenings

What days are you available?  Mon    Tue  Wed  Thu  Fri    Sat

How many hours per week or month are you available?

Weekly          Monthly