Volunteer Application - Individual
Please fill out the form below, and a member of our staff will contact you shortly.
Your Name
First Name *
Last Name *
chl88lfvzkin
Email (Required)
Phone (Required)
Phone (Required)
ext
Extension
Address
City
State
Zip Code
Birthdate (Required)
Are you a veteran?
Yes
No
Do you speak any additional languages? (Required)
Do you speak any additional languages? (Required)
-----
Yes
No
If yes, please list.
What days of the week are you available? (Select all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
What time slots are you most available? (Select all that apply)
8:00AM - 11:00AM
11:00 - 2:00PM
2:00PM - 5:00PM
Why do you want to volunteer at Sixty & Better? (Required)
Which volunteer opportunities are you interested in? (Select all that apply)
Talk Time Companion Calls
A Matter of Balance Health Educator
Bingocize Health Educator
Creativity Lab Facilitator
Intern
Medical Professional Volunteer
I understand that I must submit to a criminal background check.
Yes
No
I understand that all volunteers must undergo orientation and training before beginning volunteer service.
Yes
No
Submit my application
Please contact me
