United Way Volunteer Center Form

United Way Volunteer Center Form

Count Me In. I want to help enrich the lives of others in my community. Please call me about volunteer opportunities. I understand there is no obligation. (Note: Your name and information will not be released to any mailing list company.)

Name:
Street Address:
City, State, Zip:
E-Mail:
Home phone: Work phone:
Best time to reach:
Areas of Interest: (Check all that apply)
Adoption Services AIDS/HIV Airplanes Animals Child Care Citizenship Committee Work Computers Construction Counseling Court System Crafts Crisis Lines Disaster Services Domestic Violence/Abuse Driving/Transportation Education/Teaching Employment	English as a Second Language/ESL Environment Issues/Nature Family Intervention Financial Assistance/Education Food Services Foreign Languages Foster Grandparents Gardening/Yard Work GED Preparation Homelessness Hospitals/Medical Library Literacy Mentoring Museum Neighborhood Associations		Newsletter Assistance Office Activities/Phones Painting People with Disabilities Public Speaking Reading Recreation Seniors Sign Language Sort Donations Special Events Teen Moms Theatre Tour Guide Tutoring Youth Other:
Times Available:
Sunday: Monday: Tuesday: Wednesday:		Thursday: Friday: Saturday:
In which county do you want to volunteer? Sedgwick Butler Harvey Sumner
Age: Under 14 14 - 16 16 - 18 18 - 55 Over 55
Are you required to perform community service? (Ex. for school) No Yes If yes, please explain:
Referred by:
Newspaper ad Newspaper article Television ad Radio Billboard		Internet Web Site Brochure Friend Other:

To Contact United Way Volunteer Center by E-mail: volcenter@unitedwayplains.org