Volunteer

First Name (required)

Last Name (required)

Email Address (required)

Phone

Mailing Address

City

State

Zip

Reasons for wanting to volunteer:
I believe in the cause/goals/mission of the Hub and want to support itTo meet new people/make new friendsTo feel useful/neededTo have funTo learn a new skillTo refresh an old skillTo fulfill a community service requirement (school, work, church)To spend quality time with family/friends by volunteering togetherTo get out of the house

Volunteer Opportunities (please indicate your interest below - check all that apply):
Home Delivered Meals DriverSenior Companion- SheridanFamily Caregiver SupportHandy Man ServicesSenior Companion- Tongue RiverDining Room DeskBuildings/Grounds MaintenanceRegistrarShare a Special Skill/TalentDining Room Senior CenterDining Room Heritage TowersSpecial EventsFundraisers/Keystone AwardsDevelopment/Grant WritingSocial Activities (Cards/Pool)Thrift Store Green BoomerangTransportation HelperGrab and Go VolunteerNewsletter MailingsAdministrative AssistanceClericalYoung at Heart Theater GroupComputer AssistanceCrafts/HobbiesInstructors (Exercise/Computers, etc.)Sheridan Aires Singing GroupEntertainment/Special Music

Other Interests Not Listed

Time Commitment and Availability - check all that apply):
MondayTuesdayWednesdayThursdayFridayWeekendsA.M.P.M.

Summarize relevant work experience:

Summarize relevant volunteer experience:

Summarize education and/or special training:

Summarize your interests, abilities, any special skills/hobbies:

How did you find out about this volunteer opportunity?

Who referred you?

PLEASE LIST 2 REFERENCES:

Reference 1 Name:

Reference 1 Relationship:

Reference 1 Phone:

Reference 2 Name:

Reference 2 Relationship:

Reference 2 Phone:

Physical Limitations (e.g., no heavy lifting, limited walking, limited hearing/vision, etc.):

EMERGENCY CONTACT:

Name

Phone

Relationship

Street Address

City

State

AUTHORIZATION OF RELEASE:

By submitting this document, I authorize The Hub on Smith to conduct an Adult Central Registry Screen, a National Sex Offender (NSO) check and contact the references I have listed above. I also understand that I may withhold my permission and that in such a case, no investigation will done, and my volunteer application not be processed further.