Name:
Today's Date (mm/dd/yy):
Address1:
Address2:
City:
State:
Zip:
Day Phone #:
Home
Work
Evening Phone #:
Home
Work
Cell Phone #:
E-Mail:
Current Employer:
Current Occupation:
IMPORTANT: Volunteers must be 18 years of age and out of high school.
Do you meet BOTH of these qualifications? Yes
No
Please check the skills you are willing to use for ActionAIDS:
Sign Language
Spanish
Clerical
Party Planning
Special Events
Transportation
Telephone Work
Public Speaking
Errands
Other:
Additional explanation of your skills:
IMPORTANT PLEASE ENTER THE DATE OF THE ORIENTATION YOU WILL ATTEND:
We will help you to choose a specific volunteer assignment later. For now, please indicate a general area of volunteer interest:
Buddy
Special
Transportation
Recruitment
Errands
Not Sure
Other
Have you volunteered at ActionAIDS previously?
Yes
No
If "Yes", in what capacity?
How did you learn about us?:
If you own or have access to a vehicle, what type is it?
No Car
Car
Wagon
Van
Truck
License & Insurance?:
Yes
No
Are you fluent in any language other than English?
Yes
No
If Yes, please specify:
Hobbies and/or life experience:
Please list your membership in any business/professional associations:
Our Board of Directors has mandated that we run a Criminal History and Child Abuse Clearance on ALL volunteers. We will run these checks AFTER you come to an orientation.
PLEASE NOTE: Conviction of felony or misdemeanor, or other forms of criminal history may limit the scope of your volunteer work or completely prevent you from volunteering with ActionAIDS.
You MUST indicate at least two (2) people whom we should contact in case of emergency:
Name:
Telephone #: Relationship:
Name:
Telephone #:
Relationship:
Optional Information: Diversity in our volunteer program is VERY important. Please help us by completing this short profile:
Birth Date (mm/dd/yy):
Gender: Male
Female
Transgender
Race:
White/caucasion
African American/Black
Latino/Hispanic
Asian
Native/First American
Other (please specify):
Other Notes:
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