Volunteer Connections

I Volunteer Day! Saturday, April 21, 2007 - Individual Application Red fields are required. Any questions? Call 303.444.4904
First Name:
Middle Initial:
Last Name:
Prefer to be called (nickname):
Email Address:
Street Address:
City:
Zip Code:
Home Phone:
Work Phone:
Cell Number:
Birth Date:
May we call you at work?:	Yes No
Employer or Group Name:
How did you learn about I Volunteer! Day:	Another Agency Employer Religious Organization Habitat for Humanity Friend/ parent/teacher Internet Paper-Broomfield Enterprise Paper-Boulder Daily Camera Paper-Longmont Times-Call Paper-Louisville or Lafayette MySpace Radio CU VCH School-grade/ high School-other beyond high School-University of Colorado Volunteer Connection Monthly Email Bulletin Volunteer Connection Event Other - please list or describe
Are you an adult planning to bring youth with you? If so, please include name(s) and age(s):
Name:
Age:
Name:
Age:
Name:
Age:
Emergency Contact Name:
Relationship:
Phone Number (Day):
Phone Number (Evening):
Are you a CU student, staff or faculty member? Yes No
Project Selection Please read through the available projects and then list your top 3 project selections by number and title. We will make every effort to place you in one of your top three selections. If we are unable to meet your request due to available project space, we will contact you. When you have been placed, the Volunteer Connection will contact you with further information.
First Choice #:
First Choice Title:
Second Choice #:
Second Choice Title:
Third Choice #:
Third Choice Title:
Or:	Please place us where we are most needed.
T-Shirt Size:	S M L XL
We will do our best to accommodate any physical challenges or special needs your group may require. Does anyone in your group have any special considerations that we should know about?:

Volunteer Connection Anti-discrimination Statement: To fully promote equal employment and volunteer opportunities, the Volunteer Connection will affirmatively follow principles and practices designed to ensure equal opportunity for all qualified individuals, without regard to race, color, religion, military status, martial status, sex, gender variance, sexual orientation, age, handicap, or national origin.

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