JCA Interages® Volunteer Application
Name
*
First Name
Last Name
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Are you over age 50+
*
Yes
No
If you are YOUNGER than 50, please stop and contact the Volunteer Manager.
Volunteer Manager: Bonnie Leko-Shapiro at bonnie.leko-shapiro@accessjca.org
How did you hear about JCA Interages?
Word of Mouth
Newspaper Ad
Internet Search
JCA Website
Volunteering Website
For which program(s) are you applying?
REAL
Grandreaders
Bridges
Everybody Counts
Dialogues Across the Ages
Read Aloud
What experience(s) do you have with young people? (As a teacher, parents, mentor, volunteer, neighbor, etc.):
*
Please share a bit about yourself and your life experiences to help us get acquainted with you (homes, hobbies, talents, travel, memberships, education, etc.):
*
Briefly describe an experience you had with an adult (other than a parent) who influenced you positively as a child:
*
Do you drive or are you able to otherwise arrange your own transportation?
*
Yes
No
Describe any potential restrictions on your volunteer time, such as health limitations, frequent travel, planned trips, other work or volunteer activities, which might interfere with volunteering:
*
References
Please provide the names and contact information of two people who know you well enough to vouch for your character and suitability as a volunteer in one of our programs. (Select people who are not your family members. References will remain strictly confidential).
Reference 1: Name
*
First Name
Last Name
Reference 1: Email
example@example.com
Reference 1: Phone Number
-
Area Code
Phone Number
Reference 1: Relationship?
*
Reference 2: Name
*
First Name
Last Name
Reference 2: Email
example@example.com
Reference 2: Phone Number
-
Area Code
Phone Number
Reference 2: Relationship?
*
Finally...
Have you ever been convicted of a crime other than a traffic violation?
*
YES
NO
IF YES, PLEASE EXPLAIN:
By clicking "AGREE", I certify that:
The above information is true to the best of my knowledge. I grant permission to Interages® to contact the references provided. I also understand that any information provided on this application, or over the course of my service, found to be untrue will be grounds for dismissal from participating in the Interages® programs. We require a criminal background check of all volunteers prior to the start of your service with us. We conduct the background check using a private company at no expense to the volunteer. We are unable to accept any background check reports you may have received from previous employers or other nonprofit organizations with whom you have volunteered.
*
AGREE
DO NOT AGREE
Submit
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