Volunteer Application - Individual

"*" indicates required fields

Name*
MM slash DD slash YYYY
Address*
Are you 18 or older?*
Any special health restrictions (lifting, stairs, allergies, medical conditions, etc.)*
Are you willing to submit a background check through Sojourner Truth House?*
Are you able to lift / pull 50 lbs?*

EDUCATION

Are you a high school graduate?*
Are you a current college student?
Are you looking for college-related volunteer hours?

EMERGENCY CONTACT

Full name*
Address*

AVAILABILITY

Please indicate the day(s) that you are available. Our volunteer hours are between 7:30 am – 4:00 pm Monday through Friday.
Check all that apply.
Please check all areas that you are interested in volunteering:

DISCLAIMER and E-SIGNATURE

I hereby certify that there no willful misrepresentations in, and no falsifications of the foregoing statements and answers to questions. I give consent to Sojourner Truth House staff for verification of this information, and I am aware that should investigation disclose such misrepresentation and falsification, my application will be rejected, or I will lose my volunteer position with the organization

Signature of application:*
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.