| * Required Fields |
| Gateway Community Action Partnership |
| Volunteer Application |
| Department or Position Applying For:(If unknown, type "General") |
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| Name: |
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| Street Address: |
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| Town: |
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| State: |
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| Zip Code: |
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| Phone Number: |
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| E-mail: |
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| Date of birth: (mm/dd/yyyy) |
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| Emergency Contact- Name: |
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| Emergency Contact- Phone: |
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| If you are under 18, do you have a sponsor? |
Yes
No
N/A
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| Sponsor Name: |
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| Sponsor Contact Number: |
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| * Please note: Minors under 18 must be sponsored to volunteer by a sending organization or a parent/guardian. |
| How did you learn about volunteer opportunities with Gateway? |
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| Areas of interest (Please check all that apply) |
Childcare- Head Start/Early Learning Center/After-School
Literacy Helper (tutoring, assisting with Literacy program)
Angel Food Network/Gleaning (meal programs)
Mill Creek Urban Farm
Economic Development (community involvement, data entry)
Health and Dental Health Activities(Tooth Mobile, assisting with screenings, tooth brushing)
Clerical/Administrative (answering phones, greeting center visitors, computer entry)
Other
Please explain:
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| Skills (Please Check all that apply) |
Computer literate
Spanish speaker
Event planning
Physical strength
Tutoring experience
Experience with children
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| Additional Comments (Skills, experience, etc) |
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| Availability- How often can you volunteer? |
Regularly each week
1-2 times per month
Special projects/events
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| If you are available to volunteer regularly, how many hours can you serve each time? |
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| Days and times available (Check all that apply) |
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| If you plan to volunteer on a regular, weekly basis with any of our childcare programs, you are required to have a physical and a Tuberculosis test and submit to a background check and fingerprinting. |
| If you have ever been convicted of a crime or have pending charges, please explain offense and surrounding circumstances. (This information remains confidential.) |
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| Are you willing to submit to a Child Abuse Record Information and Fingerprinting Check? |
Yes No |
| Please list two references (at least one non-relative) with current address and phone numbers. |
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| Please initial here to certify that all information included in this application is accurate and truthful. |
| Volunteer Signature |
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| Signature Date: (mm/dd/yyyy) |
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| If under 18 |
| Parent/Guardian/Sending Agency Signature |
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| Parent/Guardian/Sending Agency Phone: |
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| Parent/Guardian/Sending Agency E-mail: |
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| Verify |
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