Your Name *

Date*

Date of Birth*

Your Email *

Home Phone*

Work Phone

Cell Phone

Address *

City *

Postal Code*

Occupation Status Employed Student Unemployed Retired

Occupation/ Major*

Employer / School*

May we contact you at your workplace?  Yes No

Have You had a Tour at Rising Above?  Yes No

If so on what date?

Comments

Emergency Contact

Name*

Phone*

Church Information

If applicable what chirch do you attend?

Pastor's Name

Volunteer Experience

Have you volunteered at Rising Above before?  Yes No

If yes, in what area did you volunteer?

Volunteer Comments: Briefly list and discuss any experience that you may have in volunteering with charitable organizations, community service groups, or working with the church. Please include any training, workshops or seminars that you have attended.

Talent & Availability

I would like to volunteer in the following areas:  Mentorship Maintenance/Construction Events Fundraising Life-Skill Development Office

Why would you like to volunteer here at Rising Above? Please include any practical skills, talents or gifts you possess or are developing and believe may benefit in the pursuit of our mission:

Which day(s) of the week and hours of each day are you available to volunteer?

Do you have any medical or environmental concerns we should be aware of? If so, please explain:

References

Please list two references. We would prefer that you name people such as employers, your pastor or a place where you volunteer. Please do not list family members.

Reference 1

Name *

Phone Day*

Phone Evening

How long has this reference known you? *

Reference 2

Name *

Phone Day*

Phone Evening

How long has this reference known you? *

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