Volunteer Form

General Information & Contact Info

Name

FirstLast

Email

Mailing Address

Street AddressCityStateZip Code

Home Phone

Cell Phone

Work Phone

Preferred Method of Contact

Email
Home Phone
Cell Phone
Work Phone

Emergency Contact

Emergency Phone Number

Date of Birth

MM

DD

YYYY

Have you previously volunteered with Mid Valley Mentors? If so, please list past experiences*

Gender

Male
Female

Race/Ethnicity

Do you speak a second language (besides English)

Spanish
Other

T- Shirt Size - (Please select your size below)*

How did you hear about our program?*

If you chose 'other' please indicate below how you heard about us.

Accomodations

Do you need accommodations becasue of a disability?

My Preferences

I am a . . .*

Please choose the option that best describes you.

My Program Preferences:

Please choose areas in which you prefer or are willing to work. *Some volunteer duties will overlap into multiple progams.

I prefer to serve . . .

Adults
Youth
Indirect Service Only (office, events, etc.)
No Preference

I am interested in the following volunteer opportunities: (If you choose Mentoring, you will need to fill out a secondary form. The link will appear on the thank you page after you submit this form.)*

Comments - or - if you chose 'other' as a volunteer opportunity please indicate your interest below.

Authorization & Disclosures

Have you ever been convicted of a felony?*

Background Check Authorization: Do you authorize Mid Valley Mentors to perform a background check on you? (described below)*

All volunteers with Mid Valley Mentors are required to have a background check that include a nationwide check of criminal and sex offender records. This background check will be performed at no cost to you.

Availability

When are you available to volunteer? (day/s of week, time/s of day)*

How often are you available to volunteer?*

Available hours per week:*

Skills and Experience

Describe your volunteer experience (if any).*

Please include name of agency, length of service, role/position, and any duties performed.

Current Employer's Name

Current Employer's Location (City, State)

Occupation/Title*

Current Employer's Phone Number

Other Work History.

Please describe any other past work experiences you feel are relevant to this position.

Education

Highest Level of Education

Degree/s Received

Degree Date

Name of School/College/University

References

References may not be a family member. Students please include at least one professor as a reference.

Reference #1 Name*

FirstLast

Relationship & Years Known

Phone

Address

Street AddressCityState / Province / RegionZip / Postal Code

Reference #2 Name*

FirstLast

Relationship & Years Known

Phone

Address

Street AddressCityState / Province / RegionZip / Postal Code

Questions

Please answer the questions below.

Why do you want to volunteer with Mid Valley Mentors?

What do you hope to gain or accomplish from the experience?

What frustrates you the most in a work/volunteer situation?

What skills do you need or would like to improve?

Rate your people skills on a scale of 1-5 (5 being highest) and tell us why you chose that number.

What skills or attributes do you possess that make you a desirable volunteer? (Can include art, theatre, workshops, translating, sports, or other past experiences, etc.)

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Engage

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Volunteer Application

General Information & Contact Info

Accomodations

My Preferences

Authorization & Disclosures

Availability

Skills and Experience

Education

References

Questions

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