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 yhanon@inmed.org

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