Sojourner Truth House

VOLUNTEER APPLICATION

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Applicant Information

Last Name

First Name

Middle initial

Date

Address

Apartment/Unit #

City

State

Zip Code

Home Phone

Cell Phone

Are you under the age of 18? If yes, how old are you?

Do you have a drivers license?

Yes

Driver's License Number and State

Education

Current High School Student?

Yes

High School Graduate?

Yes

College Student?

Yes

Name of College

Name of Degree

Do you have Transportation?

Yes

Volunteer Experience

Special Skills, Hobbies, Areas of Interest

Courses & Training (e.g. first aid, CPR)

Special information (e.g. allergies)

Yes

Special needs/health restrictions

Yes

If yes to the above, please provide more information and action plan

Emergency Contact

In case of an emergency, who can we notify?

Full Name

Address

Apartment/Unit #

City

State

Zip Code

Home Phone

Cell Phone

Availability

How often can you volunteer? Please indicate the day and the time frame between the hours of 7:30 AM and 4:00 PM Monday through Friday.

Monday Finish

Monday Start

Tuesday Start

Tuesday Finish

Wednesday Start

Wednesday Finish

Thursday Start

Thursday Finish

Friday Start

Friday Finish

Weekend Special Events Start

Weekend Special Events Finish

Please check the areas where you would be interested in volunteering.

By submitting this form I certify that there are 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 program.