Basic Information

Today's Date
Name		DOB (mm/dd/yyyy)
School		Year in School

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

Contact Information

Address		City
State		Zip
Home Phone		Cell
			Can our UAY volunteer Coordinator send texts?
			YesNo
Email
Social Media	Facebook		Myspace
			Screen Name:

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

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 agree to give notice to UAY should I be unable to fulfill my commitment and maintain UAY's standard of confidentiality. I will be responsible to the volunteer coordinator for fulfilling my commitment of volunteering. I understand that the Director, Volunteer Coordinator, or other supervisor may evaluate my performance and that any record of that evaluation will be maintained at UAY and will be available for my review. If under 18, please include a signature from an adult parent/ guardian.

My Name		I agree
Parent/Guardian 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.