VOLUNTEER APPLICATION Order Number First Name * Phone Number * Last Name * Email Address * Address * City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP * Are you 18 or Older? * Yes No Language(s) spoken: Are you a former or current client of the YWCA NH? * Yes No If former client, when did you last receive services? Do you have any friends, relatives or acquaintances working for YWCA NH? * Yes No If yes, please state name and relationship: Do you have a valid driver’s license and dependable access to a car? * Yes No In one sentence, please explain why you are interested in volunteering for YWCA NH * Please check the volunteer opportunities which interest you: REACH Crisis Service Special events/fundraising Other (describe below) Other certify-1 I certify that the facts contained in the application are accurate and complete to the best of my knowledge and understand that falsified statements on this document will be grounds for refusal. certify-2 I agree to provide references/additional information upon request in which case I would permit YWCA NH to examine my references, record of employment, education record, and any other information I have provided. In addition, I release YWCA NH, my former/current employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such examination or revelation. certify-3 I am prepared to receive training and to devote to the agreed time. I will not hold YWCA NH and or its affiliates responsible for any injury incurred as a volunteer. Full Name * Today's Date *
