Volunteer Application

* First Name   * Last Name

Email

Phone Number   * Home           Alternate:

* Address

* City

* State AKAZARCACOCTDEDCFLGAIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

* Zip

Emergency Contact Name (First and Last)

Relationship

Phone #

For Students Only

Permanent Address (if different from above)

City

State  AKAZARCACOCTDEDCFLGAIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip

School

Year of Study

Major

Volunteer Experience
Please list two most recent volunteer experiences

Agency

Phone #

Duties

From   To

Agency

Phone #

Duties

From   To

* Why do you want to volunteer at Bryn Mawr Terrace?

Availability (Check Boxes)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Mornings

Afternoons

Evenings

To the best of your knowledge, will you be available as a volunteer for at least six months from this date? Yes    No

If not, how long do you think you will be available?

What kinds of services are you interested in providing at Bryn Mawr Terrace?

1:1 visits with residents

transporting residents to programs

providing musical entertainment

office/clerical work

assisting with small group activities

other

Work Experience:
Please list two most recent employers:

Employer

Phone #

Position

From   To:

Employer

Phone #

Position

From   To:

Have you ever pleaded guilty to or been convicted of a felony or misdemeanor crime? Yes    No

If yes, please explain:

* References

Name

Relationship

Address

Phone #

Name

Relationship

Address

Phone #