Please complete this application form if you are interested in becoming an Early Head Start/Head Start Intern or volunteer at Community Action. Once you complete the form, click the submit button at the bottom.

* ARE REQUIRED FIELDS

You must be at least 17 years of age or older to Volunteer at Community Action Early Head Start or Head Start programs.

If you are under the age of 19, you will need parent signatures on our release forms and your parent guardian will need to assist you in completing the DHHS Child Abuse Registry check link you will be sent.

**If you are wanting to volunteer, please do not fill out the sections with (interns/practicum) only listed.

Please call or email Sam Bates, Community Engagement Partnerships Specialist, for more information or if you have questions about the process at (402) 875-9320 or sbates@communityactionatwork.org.

The volunteer processing can take up to 2 weeks to complete, including time for background and DHHS checks.

Demographic Information

Please include the following information to verify your eligibility to be a Volunteer/Intern.

First name:

Last name:

Are you under the age of 19?:

Street 1:

Street 2:

City:

State:

* Zip: *

Primary Phone phone:

Email address:

Date of birth:

Ethnicity:

Primary Language:

How did you hear about us?:

Preferred Pronouns:

Check the appropriate checkbox for your experience

Please check if you are interested in being an Intern, a Volunteer or Practicum/Student Teacher.

* Title:

Group

Intern

Practicum Student

Volunteer

What volunteer experiences are you interested in?

Please click or type in the comment box what volunteer experience in which you are applying.
Example: EHS homebased volunteer, classroom Intern/volunteer, food prep volunteer, etc.

Edu or field of study (Interns/Practicum only)

Please list your major or field of study

Personal Development

Please write a short paragraph about what goals you would like to reach during your time with us. (Note, for Interns and Practicum students - a copy of your syllabus is required. Email to sbates@communityactionatwork.org)

Professional & Personal Experience

Please provide employment & volunteer experiences, especially those in child development settings, you've had in the last year .

1

2

Employer or Business name:

First name:

Last name:

Email address:

Please enter any other information you want us to know.

Skills

Please check what talents you bring with you to Community Action.

Please select language(s) you are proficient in.

Please list any languages that you can read, write or speak fluently. *Check ALL that apply.

Availability

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

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

Availability - Dates/Hours

Enter any information regarding when you need hours completed (if applicable) and when you are available to start.

Total number of hours needed:

Hours need to be completed by:

Date you are available to start:

I want to serve ____ weekly hours:

Community Action Updates

We strive to keep the community informed of important Community Action news, updates, fundraising, events, and volunteer opportunities. Keep the box checked if you agree to be contacted by Community Action.

What kinds of email would you like to receive?

Updates
I agree to be contacted by Community Action with volunteer updates and other organization communications.

Schedule reminders
Your volunteer schedule.

Volunteer Information Center - VicTouch

Community Action Early Head Start/Head Start provides a Volunteer Information Center (VIC) which allows you track your volunteer hours.

During your orientation you will be assigned a 4 digit PIN that you'll use to log-in.

Please enter a password that:

Is between 4 and 30 characters long

Password:

Confirm password:

Electronic Signature

I authorize Community Action Partnership of Lancaster and Saunders Counties to investigate all information contained in this application and I authorize all persons, institutions, organizations and companies to furnish all pertinent information known to them about me. I certify that all statements are true and complete to the best of my knowledge and I understand that to knowingly misrepresent and/or omit facts called for herein will be sufficient cause for cancellation of consideration for volunteering or dismissal. I will also indemnify Community Action against any liability which might result from making such investigation.

By checking the "I agree" checkbox, you are agreeing to abide by the policies and practices established.

I Agree