Elizabeth Gregory Home · Volunteer Form

The following information will assist us in matching your skills/interest with program needs. All personal information will be kept confidential.

Contact Information

Name

*

First Name

Last Name

Email

*

Vol. Phone

*

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Birthdate

Format - 01/01/2017

My Gender is

Female

Trans

Male

Education Background

Current Employer/School

Occupation/Field of Study

Volunteer Experience

Scheduling

Please let us know when you are available

Monday

Tuesday

Wednesday

Thursday

Friday

Shifts

9am - 1 pm

1pm - 5pm

I can give EGH a commitment of

Please choose one

1 year or longer

6 months

3 months

One time

Other

Do you have any physical, mental or emotional limitations we can assist in accommodating with your volunteer experience? Please specify

References

References other than family

Name

First Name

Last Name

Ref. 1 Phone

Email

Name

First Name

Last Name

Ref. 2 Phone

Email

Emergency Contact info

Person to contact in case of emergency

Name

*

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

ICE Phone

*

Email

Our Policy

It is the policy of Elizabeth Gregory Home to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age or disability.

Agreement and Signature

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my dismissal.

Signature

Date

(mm/dd/yyyy)

Thank you for completing this application form and for your interest in volunteering with EGH.