Name:       Last: First: Middle:

Address: Street: City: Zip:

              Phone#:    E-Mail:

Date of Birth:   Drivers License #, Exp Date:

Previous Volunteer Experience:

Work Experience: (please list name of employer, hours, and duties for most current employemnt)

Briefly explain why you would like to volunteer for Grand Valley Catholic Outreach:

List any Special Skills, Training, or interests you have: (include languages other that english)

Education:     H.S. diploma/GED:        College:       Degree Received:

Check areas of most interest for volunteering: 

Main Office: Book-in-Hand: Clothing Bank: Day Center: Soup Kitchen: Fundraisers:

What days and times are you available for volunteer work:        M: T: W: TH: F:

List two personal references other than family: (name, address, phone#, relationship)

Do you have any special needs or health limitations?     Yes:   No:
If yes, explain:

Have you ever been arrested or convicted of a felony?    Yes:   No:
If yes, explain:

How did you hear about our program?:

How would you like to be contacted?: E-mail:   Telephone:

I certify that this information is true and accurate to the best of my knowledge and I grant GVCO permission to contact the references I have provided:   Date:

(You will be required to sign a printed copy of this application prior to acceptance in the program)
(If under age 18, a parent or legal guardian must also sign this application prior to acceptance in the program)