Volunteer Application Form Page 2
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2SKILLS INVENTORY: Check any of the following areas in which you have special skills
and/or areas of interest:
ADMINISTRATIVE:
SOCIAL/RECREATIONAL
____Reception
____ Physical fitness
rafts
____Clerical
____ C
____ Newsletters
____ Community Trips
Dance
____ Word processing
____
Games
____ I.T. expertise
____
Movies
____Other (please describe)
____
Sports
____
Music
PERSONAL SERVICE:
____
Religious activities
____
Arts
____Friendly visiting/walking
____
Sewing
____Writing letters/completing forms
____
Cooking
____Run errands/personal shopper
____
Plant care/Greenhouse
____Transportation/escort
____
Other (please describe)
____Mending/ironing
____
____Reading/translating
________________________
____Grooming (e.g. hair needs)
____Laundry assistance
SPECIALIZED SERVICES
____Other (please describe)
____Personal care
____Tax preparation
In what areas are you interested in volunteering?
____Conservatorship
1. ______________________________
____Counseling
2. ______________________________
____Therapy
3. ______________________________
____Special Needs Trusts
____Estate Planning/DD Benefits
____ASL
____Other (please describe)
REFERENCE INFORMATION:
Please provide the names and phone numbers of two references.
1. ___________________________________________________________________
2. ___________________________________________________________________
I am requesting the Volunteer Handbook in order to read and review the volunteer
polices and procedures.
________________________________
____________________________
Volunteer Signature
Date
I understand that I may be required to have a TB test, complete a criminal background check and
submit fingerprint cards.
For Office Use Only:
Reference Check ___ Date _____ Initials ____
Security Check ___ Date _____ Initials ____
VOLUNTEER APPLICATION FORM
Use only as authorized by
Stephen’s Place 2-15
2
initials _____
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