First Name : Last Name : Address: City: State: Zip code :     Gender: Cell phone: Time range: Home phone: Time range: Work phone: Time range: Fax: Email: What is the best way to contact you? Email Phone Date of Birth : How did you hear about us?  Are you interested in serving on a Non-profit Board? Yes No Previous Volunteer Experience: Optional Retired? Yes No Occupation(s) Education and years completed Degree(s) Other

Select Skills You Want to Share in a Nonprofit Organization by clicking the appropriate boxes:

Accounting/Finance Arts/Crafts Child Care Clerical Computers Cook Construction Counseling Consulting Driving Entertainment Friendly Visiting Foreign Language(s) Fundraising Health Care Law Management Marketing Music/Drama Public Speaking Public Relations Reception Sports/Coaching Teaching/Tutoring   Other (Specify)

Please prioritize your interest area(s) for your volunteer work. Number your selections sequentially, with "1" being your first choice, "2" your second choice, etc. Priority Issues:

Adoptions  AIDS Services Animals  Athletics Battered Women Chambers of Commerce Churches Convalescent Hospital Counseling Services Crafts Development Disaster Relief Education Environment Friendly Visiting Fund Raising Health Services Homeless Legal Aid Services Libraries Literacy Programs Medical Facilities Museums & Gardens Mental/Emotional Health Nutrition/Low Income Parks & Recreation Performing Arts Political Action Groups Senior Programs  Sexual Assault Substance Abuse Telephone Hotlines Thrift Stores Women's Issues Youth General Office Children (Specify)  Disabled (Specify) Other (Specify)  .

Location where you wish to volunteer: Available Transportation Bus Bicycle Car Taxi Walk Other (Specify below) Hours and days you are available Flexible hours Preferred Group Served Children Teens Adults Seniors Disabled Other (Specify) Preferred Assignment Short Term OnGoing One Day May the agency contact you? Yes No Do you know of a particular agency you would like to work with? Yes No If yes, please specify: Do you know what you would like to get involved in? Comments/Suggestions: