
	To Volunteer Please Fill Out The Form Below

Name:

Address:

City/Zip:

Home Phone:

Work Phone

Employer:

Occupation:

Other languages:

E-mail:

In Case of Emergency Contact:

Name:

Relationship:

Address:

Work phone:

Home Phone:

Do you have a medical condition we should be aware of? Yes No

If yes, please describe:

I would like to volunteer in the following area(s):

Data Entry Work
Weekly Office Work (requires a set schedule)
On-call Office Work
Special Events/Outreach Projects
Member Support Phone Campaigns

Yes, I think my company would like to get involved in a membership campaign.

My Availability:

Mon

morning

afternoon

evening

Tue

morning

afternoon

evening

Wed

morning

afternoon

evening

Thur

morning

afternoon

evening

Fri

morning

afternoon

evening

Sat

morning

afternoon

evening

Sun

morning

afternoon

evening

Computer Skills

	Microsoft Word	Microsoft Excel	Word Perfect	Database Experience

Other:

No experience with computers but am willing to learn

Special skills, jobs, or activities you enjoy:

Other organizations, service clubs or charity groups with which you are involved:

Are there specific jobs you would like to do?

Are there specific jobs you do not like to do?

We all have interesting backgrounds.
Please share some information about yourself.

Newspaper (s) you read regularly

Types of books you enjoy

Favorite KTWU Program

I understand The information you provide is voluntary and confidential
and will not be released without your written permission.