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Volunteer Application

Personal Information

*Name:	First: Last:
*Street:
*City:	State: Zip:
*Email:
Phone:
*Are you over the age of 18? Yes No

Interest & Experience How did you hear about volunteering at CYF? (Example: friend, website, newspaper, other):

What experience do you have working with children?

What is your volunteer experience?

Why is volunteering at this stage in your life valuable to you?

How does your family, spouse or significant other feel about you volunteering?

Briefly explain your feelings about child abuse and child neglect in your community:

Have you had any exposure to or experience with drug or alcohol addiction and/or recovery in your work or family?

References Name: Phone:

Name: Phone:

Employment Where do you work if employed?

How many hours a week?

Availability & Skills How many hours a week would you like to donate to volunteering?

What days of the week are you available? (check all that apply)
Sun Mon Tue Wed Thu Fri Sat

Special skills or interests:

Education Are you currently enrolled in school? Yes No

What school?

What year?

What field?

If Social work, Sociology or similar, are you interested in an Internship with DHS now or in the future?

*Have you ever been convicted of any law violation (include whether you are currently subject to a deferred sentence) except a minor traffic violation?

Yes No

If Yes, please explain.

By checking the box below and entering my name in the signature field, I confirm that all of the above information is correct.

*Check this box to agree with the above statement.

*Signature: