Basic Information

Today's Date
Name		DOB (mm/dd/yyyy)
Address		City
State		Zip
Home Phone		Cell
Email
Social Media	Facebook		Twitter
			Screen Name:
Name of High School:		Graduated?	Yes | No
Name of College:		Graduated?	Yes | No
Other Education or Training:

Volunteer Interest:

	Long term (3 month minimum)
	Short Term	Community Service Requirement?	Yes | No
		Hours needed:
		Requirement:
		Charges (if applicable):
		Probation Officer's Contact Information (if applicable):
	Special Event

Quick Profile

Do you speak any other languages besides english? If so, list.

How did you hear about UAY's volunteer program?

What made you interested in volunteering with UAY?

What type of volunteer activities are you interested in?

Select all that apply. Keep in mind not all of these areas need help at this time. We encourage you to select all the areas you may be interested in to fit our needs at UAY! Thanks!

Music and Art	Music and Recording Studio Arts Studio Graphic Design After School Art Programs Dance & Drama Band Show Assistance
Outreach	Youth Center Activities Teen Parent Program/Respite Childcare Academic Mentoring Program (AMP)
Leadership	Peer Education Street Outreach The DO Crew
Office	Youth Board Clerical Help Reception & Phones
Other	Special Projects Internet Assistance Videographer/Photographer for Special Events

Tell us about any previous employment or volunteer experiences you've had.

What sorts of interests or skills do you have? Are there any you would like to learn more about? (i.e. photography, sports, music, writing, etc)

Availability

When would you be available to volunteer? Our main office is open 9-5, Youth Center generally open 2-7 & varies by time of year.

Monday		Thursday
Tuesday		Friday
Wednesday		Saturday
Months Available

What age group of young people are you most comfortable working with? (check all that apply)

0-4 Years (Infant - Preschool)

6-11 Years (Elementary)

12-14 Years (Junior High)

14-18 Years (High School)

References

Please list 3 references that you have known for at least one year, and your relationship to them. (Ex: teacher, minister, coach, family friend, employer, etc)

Name		Relationship to you
Address
Phone		Email

Name		Relationship to you
Address
Phone		Email

Name		Relationship to you
Address
Phone		Email

Signature Agreement

I hereby affirm that the information on this application is true and complete to the best of my knowledge, and agree to have any of the statements checked by the organization or its representatives. I understand that providing any false or misleading information or any omissions disqualify me from further consideration as a volunteer and may result in my immediate termination if discovered at a later date.

I authorize representatives of United Action for Youth to conduct a thorough investigation of my activities, and authorize all references provided in this application, as well as any other individuals, whom the organization or its representatives may contact, to provide all information they have about me. Furthermore, I agree to cooperate in such an investigation, and release from all liability or responsibility of United Action for Youth, all persons and entities acting on its behalf, and all persons and entities requesting or supplying such information.

My Name

I agree

I hereby give my consent to a representative of United Action for Youth to conduct a check of criminal records in regard to any felony arrests.