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Find more about Weather in Bellingham, MA


 
Volunteer Enrollment
VOLUNTEER INTAKE FORM

Initial Contact Date:______________ Interview Date:_______________ Interviewer: ________________


Name: ______________________________
Address:_________________________________________________________________
Phone number: _______________________
Business/school address:________________
Congregational/agency affiliation: ___________________________________
____________________________________
____________________________________
Gender:   M     F    Birthdate: _____________
Emergency contact: ___________________
____________________________________
Relationship: _________________________
Address:_________________________________________________________________
Phone: ______________________________
Ethnicity: ____________________________


Volunteer time available: circle
Mornings: M  T  W  TH  F        
Afternoons: M  T  W  TH  F
Nights: M  T  W  TH  F  
Weekends:   Yes ________________   No
Languages spoken: _____________________
Setting preference: _____________________

Driver’s License:               yes     no
Own a Car?                      yes     no
Length of commitment:
Willing to do “spot jobs”?      yes     no

Emergency contact: ___________________
____________________________________
Relationship: _________________________
Address:_________________________________________________________________
Phone: ______________________________

Life experience (paid/volunteer/other):______________________________________________
_____________________________________________________________________________
Skills, interests, hobbies: _________________________________________________________
_____________________________________________________________________________
Limitations and accommodations requested:__________________________________________
How you learned about the COA: __________________________________________________
Reason(s) for wanting to volunteer: ________________________________________________
Comments: ____________________________________________________________________

senior: Volunteer Intake                                                                        rev. 09Jun01