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

Education/Work Experience

Occupation

Employer

Majors/Degrees

Certifications

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)

 Academic Enrichment Assistance After School Programs/Homework Ancillary services Child Care Services Civics and Citizenship Entrepreneurship/Income Generation Family Education/Support Financial Literacy Job Readiness Mentoring School Readiness Special Events Summer Camps Wellness and Recreation Teach ESL Classes

References

Name Phone

Name Phone

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 trainings required for my position.

Please return this form by clicking on the send button below or printing and mailing it to the INMED Family & Youth Opportunity Center located at:
21630 Ridgetop Circle, Suite 130, Sterling, VA 20166

If you have any questions, please contact Erin Lewis, Volunteer/Youth Services Coordinator at elewis@inmed.org