HomeMy WebLinkAboutVolunteer application formIowa City/Johnson County Senior Center Volunteer Application
28 South Linn Street, Iowa City, IA 52240 / 319‐356‐5220
Date____________________________________
Name___________________________________ Birth Date___________________________
Address_________________________________ City, State, Zip________________________
Phone: Home___________________ Cell____________________ Work___________________
Email_________________________________________________________________________
In case of emergency, contact_____________________________________________________
Relationship______________________________ Phone______________________________
Past experience, related training, skills_______________________________________________
______________________________________________________________________________
______________________________________________________________________________
What volunteer job(s) are you interested in?
1. ____________________________________ 3. ____________________________________
2. ____________________________________ 4. ____________________________________
Are you seeking a volunteer assignment to fulfill a class requirement? Yes / No
If yes: Class name________________________ Class instructor_______________________
Number of volunteer hours needed__________ Due date ____________________________
Are you seeking a volunteer assignment to fulfill court‐ordered community service? Yes / No
Which day(s) of the week are you available? M T W Th F Sa Su
What time(s) of day are you available? Mornings Afternoons Evenings
Are you available during University breaks? Spring Summer Thanksgiving Winter
Comments: ____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
For office use only:
Volunteer position assigned_______________________________________________________________________
Notes_________________________________________________________________________________________
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Start date_____________ End date_____________ Waiver______ Name tag______ Access card______