Volunteer Application | Early Childhood Alliance

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Work Phone

Cell

Email*

Date of Birth*

Emergency Contact Information

Emergency Contact Name*

First Last

Emergency Contact Relationship*

Emergency Contact Phone*

Background - Work

Employer/retired from*

Date Employment Ended

Occupation/duties*

Background - Education

How many years of High school completed*

Name of High school

How many years of College completed*

Name of College

How many years of Graduate school completed

Name of Graduate school

More information

Prior volunteer experience

Click the + symbol to add more past volunteer experiences.

Organization name	Duties	Dates

Why do you want to volunteer?*

Skills*

Interests or hobbies*

References*

Please provide three references that we may contact. (No family members, please) Click the + sign to add references

Name	Telephone (Home and Work)	Relationship

Volunteer Opportunities*

Office Assistant: Assemble mailings, update records, photocopy or laminate materials
Office Assistant: Create arts and craft items to be used with children
Office Assistant: Data entry, word processing
Receptionist: answer phones, greet visitors, and collate materials
Messenger: deliver mail to centers and materials & equipment to various locations
Public relations assistant: attend booths and distribute materials; give tours
Building maintenance & yard work: minor repair, cleaning, and occasional outdoor work
Group projects: assemble materials, assist with bulk mailings
Other: Please describe below

Check all positions that interest you

Please explain if you selected "Other" in the previous question

Location preference*

Anthony Office (3800 N Anthony Blvd, inside Ivy Tech)
Downtown Learning Center (516 E Wayne St)
Beacon Street Learning Center at Parkview (2125 Beacon St)

What days/times of day are you available to volunteer?*

How much time do you want to volunteer?*

Any other comments about yourself or your interests?

By typing your name in the following field you are agreeing to the following items.

Permission is granted to Early Childhood Alliance to investigate your background
Permission is granted to use your picture, voice or name for publicity purposes
You knowlingly and voluntarily release Early Childhood Alliance from any liability that might result from an investigation of your background and/or participation as a volunteer

Name*

First Last

Name

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