Volunteer Application

Volunteer Contact Info:

Your Name:

Gender:

Address:

City, State:

Zip:

Are you a legal resident of the United States:

Your Email:

Your Phone #:

Emergency Contact Name:

Emergency Contact Phone #:

Skills & Other Questions

Level of education:

Career Occupation:

Languages you speak:

How did you find out about ASSIST:

Please share your reasons for wanting to volunteer with ASSIST:

Do you have any previous work volunteering? Please explain:

What are your interests and/or skills:

Do you have any physical limitations:

Are you comfortable meeting with a client in their home? (An Assist staff member will always join you at the initial visit)
YesNo

What is your computer experience? Check all that apply:
EmailSocial mediaInternet searchWord processingSpread sheets

Are you comfortable using a laptop or computer to complete applications?
YesNo

Availability:

We are seeking volunteers who can work 1 day per week, for a total of approximately 2 - 3 hours for the week. (The initial two weeks may require more time with a new Client)

Please select your time preferences on the days you are available
AM = Before Noon
PM = noon - 5p.m.
Any = Available AM or PM
Neither = Not available that day

Monday:
AMPMAnyNeither
Tuesday:
AMPMAnyNeither
Wednesday:
AMPMAnyNeither
Thursday:
AMPMAnyNeither
Friday:
AMPMAnyNeither

Are you prepared to complete 8 hours of training?
YesNo
Are you prepared to attend the once a month support meeting?
YesNo
Does your schedule permit you to attend meetings during the work day?
YesNo
Can you commit to be an ASSIST volunteer for at least one year?
YesNo

References:

First Reference:

Reference Name:

Reference Phone:

Reference Email:

Second Reference:

Reference Name:

Reference Phone:

Reference Email:

Third Reference:

Reference Name:

Reference Phone:

Reference Email:

I understand that a background check is required for all potential volunteers and that before becoming a volunteer I will need to provide additional details (social security, date of birth, vehicle model, driver's license #) to ASSIST so that a background check can be performed.
YesNo

Please prove you are human by selecting the house.

Δ