Volunteer Application Form

HAMILTON & DISTRICT EXTEND-A-FAMILY

VOLUNTEER APPLICATION FORM

Applicant's Name *

First Name Last Name

E-mail Address *

Birth Date *

Month Day Year

Home Phone Number *

Area Code Phone Number

Cell Phone Number *

Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Employer (if applicable) *

School (if applicable) *

I'm interested in the following volunteer opportunities:

Buddy Program Host Family Program ASD/REC Friendship Group Special Events Board Membership Office Assistance Other (Please explain below)

Please describe your current living arrangements, providing the first and last name of everyone who resides with you, and their age. Let us know if you have any pets, too! Thanks!

Please describe any relevant volunteer or employment experience you have had. Let us know if you have any experience working with people with special needs.

Tell us a little bit more about yourself!

Please provide the name, phone number, and e-mail address of three people who have worked with you in a work-place, school, or volunteer environment.

Reference's Name *

Phone Number *

E-Mail Address *

Reference's Name *

Phone Number *

E-Mail Address *

Reference's Name *

Phone Number *

E-Mail Address *

Enter as shown. *