Volunteer Application and Eligibility Form

First Name:

Middle Initial:

Last Name:

E-mail:

Cell Phone:

Home Phone:

Date of Birth:

Address:

City:

State:

Zip:

How long have you lived at this address?

Gender:
Male
Female

Race:

Explain why you are interested in volunteering at Sci-Tech

List Memberships in Clubs And Organizations:

List Hobbies and Special Skills:

Language(s) Spoken:

Employer / School:

Years of School Completed:

Level of Education:
High school
Trade School
College
Graduate School

Previous Occupations:

Do you have any criminal convictions (Other than parking violations and juvenile offenses)?
Yes
No

Please list two character references (not relatives)
Name:

Address:

Phone:

Name:

Address:

Phone:

Any other comments:

Emergency Contact

Name:

Address:

Phone Number:

Relationship:

Physician

Name:

Phone Number:

I am 18 or over:

Yes

I have read and agree to the terms & conditions:

Yes

You must accept the terms & conditions to submit this form.