Date      

Name    

Address

City        State:         Zip Code:

Home Phone  -           Work Phone  -

1. How did you learn of Rivers of Hope? 

2. Check the areas in which you are interested in volunteering.  This is not a commitment. Please indicate if you would like more information in a specific area.

3. List previous experience or training which may be beneficial to volunteering with Rivers of Hope.

4. What days and times would you be available:

Days: 

Su

M

Tu

W

Th

F

Sa

Times (days): 

Evenings:

Su

M

Tu

W

Th

F

Sa

Times (eve.)   

5. What geographical areas are you willing to travel?

6. Describe any volunteer work you have done.

7. Who was your Coordinator / Supervisor?       

    Phone:

8. Have you ever been convicted of a crime against a person?    Yes    No

    If yes, please explain:

9. Why do you wish to volunteer at Rivers of Hope?

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Thank you!