Volunteer

Name

First Last

Address

Street Address Address Line 2 City State ZIP / Postal Code

Phone

Date of Birth

Gender/Identity

Languages spoken, if other than English:

Race/Ethnicity

If not listed, please identify:

Are you currently enrolled in school?

Yes

If so, where?

Will this position fulfill a school requirement, or will you receive school credit for your service?

Yes

If yes, Name of School/Program:

Number of Hours Needed:

Deadline to Complete Hours:

Emergency Contact Information

In case of an emergency, please notify:

Name

First

Relationship

Phone

Medical Information

Do you have any physical limitations or medical conditions that may limit your ability to perform your volunteer duties?

Yes

If yes, please explain:

Background

Please list any other names you have used:

Driver's license or identification number:

State issued:

Have you ever been convicted of a criminal offense?

Yes

If yes, please explain:

Skills and Experience

Have you received a 40-hour Domestic Violence Certification Training?

Yes

If yes, when?

Why are you interested in volunteering with YWCA Glendale and Pasadena?

What skills, talents, or interests do you have that you would like to share?

Education and/or special training:

Volunteer Interest (select all that apply):

Other:

Schedule and Availability

Days

Monday

Tuesday

Wednesday

Thursday

Friday

Weekends

Times

Mornings

Afternoons

Evenings

References

Provide three non-relative references who have known you for at least two years. Include one person in a supervisory role who can comment on your skills and background. (Volunteer, academic, or employer roles are all acceptable).

Name

First

Phone

Name

First

Phone

Name

First

Phone

Application Agreement

I certify that all information provided in this application is true and accurate to the best of my ability. I understand that any misrepresentation or omission of information is grounds for dismissal from YWCA Glendale and Pasadena's Volunteer Program.

Signature

Date

Volunteer with YWCA Glendale and Pasadena

Emergency Contact Information

Medical Information

Background

Skills and Experience

Schedule and Availability

References

Application Agreement