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Volunteer Interest Form

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( ** indicates a required field. )
	** Enter the number at left (Prevents bogus entries)
** First Name	Your preferred first name or nickname
** Last Name	Your last name
** Primary Phone	Your primary (e.g. home) telephone number
Secondary Phone	Secondary (e.g. cell) phone number, if any
Email Address	Your email address
What would you like to do? (Please check all that apply)
Area	Specifics
Transportation	Local (< 25 miles)   Longer Distance   Brief (under 1 hour) Medium (1-2 hours)   Longer (2-4 hours)   Extended (e.g. overnight) Scheduled   Unscheduled   Wheelchair   Multi-passenger
Pickup / Delivery	Medicines   Groceries   Meals   Miscellaneous
Personal Support	Daily phone assurance   Visiting   Reading   Correspondence Caregiver relief
Household Chores	Home check   Moderate cleaning   Heavy cleaning House plant care   Pet care   Bookkeeping   Computer help
Home Maintenance	Safety check   Home adaptation   Repairs Landscaping   Lawn mowing   Snow removal
Group Activities	Lead activities   Teach classes   Assist
SNaP Administration	Committee   Telephone calling   Telephone answering   Mailings Website updates   Data entry
Task Notes
What times are good for you? (Please check all that apply)
Available    Times	Sun     Mon     Tue     Wed     Thu     Fri     Sat   Morning Afternoon Evening Overnight
What times are NOT good for you? (Please check all that apply)
UNavailable    Times	Sun     Mon     Tue     Wed     Thu     Fri     Sat   Morning Afternoon Evening Overnight
Availability Notes

Updated 03/19/08