Volunteer Form Personal Information Name (required) Date Home Address City/State/Zip Home Telephone Cell/Alternate Phone Email (required) Are you over 18 ? Yes No Preferred Method of Contact EMAIL PHONE TEXT Education/Work Experience Occupation Employer Majors/Degrees Certifications Current school (if you are a student) Grade level In the past, have you served as a volunteer for any other non-profit organizations? Yes No If yes, where? What did you do? Volunteer Interest Why are you interested in volunteering for the Center? Are there any specific skills you would like us to know about? (Ex/ bilingual, proficient in Microsoft Office) Availability (check all that apply) Monday AM Monday PM Tuesday AM Tuesday PM Wednesday AM Wednesday PM Thursday AM Thursday PM Friday AM Friday PM Saturday AM Saturday PM Program Interests (check all that apply) Child Care services After-school tutoring After-school classroom monitor Special Events Teach ESL Classes Teach computer classes Teach cooking classes Summer Camp References Name Phone Email Name Phone Email I have reviewed this application and to the best of my knowledge, the information contained is true and accurate. I understand that any false or misleading information may disqualify me from being considered as a volunteer. I also agree that by submitting this application and being considered for a volunteer position, I will complete a criminal/child abuse background check and I agree to attend an orientation and/or other training required for my position. Please return this form by clicking on the send button below or printing and mailing it to the INMED Opportunity Center located at: 21630 Ridgetop Circle, Suite 130, Sterling, VA 20166 If you have any questions, please contact Yahaira Hanon, Volunteer/Youth Services Coordinator at email@example.com Please prove you are human by selecting the House.