Thank you for your interest in the Easterseals Crossroads Volunteer Program!

Once you complete the form, click on the CONTINUE button at the bottom.

Items marked with asterisk (*) are required.

Name and address

Please provide us with the following information.

Demographic Information

Please provide us with the following information. This is used to better understand the demographic makeup of our volunteers.

Emergency Contact

Please provide the information of one emergency contact.


Please indicate the days and times you are usually available to volunteer.


Please describe any past relevant volunteer or employment experience.

Special Skills/Training

Tell us about any special skills or training you may have, including foreign languages.


Please indicate your area of interest below.

Hour Requirements

Are you required to perform a certain number of service hours? If so, how many and for what purpose?

Background Check

Easterseals Crossroads will conduct a background check on all potential volunteers. Easterseals Crossroads prohibits utilizing volunteers who have been convicted of criminal offenses that we believe, may put our consumers, current employees, the organization or the community we serve at risk. Any background check that reveals a conviction will be reviewed and considered on an individual basis. In consideration will be the nature of the crime, how long ago it occurred, and the position the person will hold while volunteering at Easterseals Crossroads. Please provide the following information needed to complete a criminal background check.

Applicant's Statement

It is hereby understood that the applicant acknowledges and agrees that he or she is aware of the potential risks involved in participating in volunteer/intern activities on behalf of Easterseals Crossroads. Whereas, it is further understood that the applicant exempts and releases Easterseals Crossroads, its officers, agents, servants and employees from any and all liability claims, demands or actions or causes of action whatsoever arising out of participation in volunteer/intern activities on behalf of Easterseals Crossroads. As a volunteer/intern, the applicant understands that he or she will earn no wages, benefits or monetary compensation and will not be entitled to unemployment insurance benefits upon the termination of this agreement or as a result of the service(s) he or she provides to Easterseals Crossroads. The applicant understands that false or misleading information given in his or her application or interviews may result in discharge. Also, the applicant understands that he or she is required to abide by all requirements of the programs, policies, and procedures of Easterseals Crossroads. Additionally, the applicant consents to Easterseals Crossroads' use of all information provided during the application process in obtaining criminal history reports. The applicant understands that he or she has the right to review and challenge any negative information that would adversely impact a decision to offer volunteerism. The applicant understands that he or she will have a reasonable opportunity to clear up any mistaken information reported within a reasonable time frame established at the discretion of Easterseals Crossroads. The applicant further understands that upon request, he or she will be provided with the name, address, and telephone number of the reporting agency as well as the nature, substance, and source of all information obtained.

This agreement shall be effective and binding upon the parties hereto for the date indicated. The parties acknowledge having read and understood this agreement.