PLEASE CHECK THE TYPES OF VOLUNTEER WORK YOU’RE INTERESTED IN:
 

Treatment Program         Library Aide         Lunchroom             Aide        Clerical  Residential Program         One-to-one         Group         Tutor         Special events         Special activities

Community Services Family Programs         Staff support         Meal preparation         Sleep over         Tutor         Clerical         Carpentry         Gardening  Prevention Program         One-to-one         Group         Family         Special activities

        Special Programs
             fund raising, special events, clerical work, other non-direct child care work

Length of commitment:

Number of hours per week you would like to volunteer:

Days and hours you may be available:

Mon	Tues	Wed	Thurs	Fri	Sat	Sun

Hours per month:
Other: 6 months 12 months More

If an intern, will you be receiving college credit for your volunteer work here? Yes No
Semester: Fall Spring

Any other previous volunteer experience? Please explain.

Any experience with emotionally disturbed children?

Why do you want to be a volunteer?

What are your expectations?

Describe some of your special skills/interests (art, music, carpentry, sewing etc.)

Do you have physical limitations that would affect your job performance?

Have you had a physical within the last year? Yes No

Have you been exposed to TB? Yes No

References: (please list here the two persons)

Name:
Relationship to Applicant:
Phone Number:

Name:
Relationship to Applicant:
Phone Number:

I hereby certify that the information I have submitted above is accurate, and I give Vanderheyden Hall’s permission to verify either my employment, or my school program,
and to contact the personal references I have listed.