Form

Name
Address
City
State
Zip Code
Home Phone
Cell Phone
Office Phone
Date of Birth (m/d/y)
E-mail
Best time(s) to reach you
Gender

Male Female
Age

15-18 18-25 26-55 55 & over
**14 and under - special circumstances only**
Employment
Current Employer
Position
Address
Phone
Education
Junior High or High School / GED
College or University
Special Training
Are you presently attending school?

Yes No
Name of School
Will you be receiving academic credit for your volunteer work?

Yes No
**If yes, please include your school requirements
Availability
Availability for Volunteering

Days Evenings Weekends
How much time would you be willing to volunteer?
Preferred Days
If you are interested in a specific program, please specify
Additional Information
What are your general areas of interest?
Current club/organizational memberships?
Have you ever served as a volunteer before?

No Yes
If yes, please specify
Describe any experience you have with children
Why do you wish to volunteer at St. David's Center?
How did you hear about St. David's Center?

Friend/Relative School St. David\'s Website Church St. David\'s Staff/Volunteer Corporation/Place of Business
If other, please specify
Have you ever been convicted of a crime (excluding traffic tickets)?

No Yes
References
One personal and two professional related (work, school, church, volunteer, etc.) with complete addresses. *Youth under 18 - all references must be professional.
1. Name
Relationship
Address
Phone
City/State/Zip
2. Name
Relationship
Address
Phone
City/State/Zip
3. Name
Relationship
Address
Phone
City/State/Zip
Should be Empty:

Employment

Education

Availability

Additional Information

References