Alexandria Adult Day Services Center
Please complete this application form if you are interested in becoming a City of Alexandria volunteer. Once you complete the form, click the submit button at the bottom.
Name and address
First name:
Last name:
Title:
Choose
Dr.
Mr.
Mrs.
Ms.
Street 1:
Street 2:
Street 3:
City:
State:
Choose
DC
DE
District of Columbia
MD
VA
Virginia
Zip:
Home phone:
OK to call me here
Work phone:
OK to call me here
Email address:
Employer name:
*
First name:
*
Last name:
*
Work phone:
*
Cell phone:
*
Email address:
*
Demographic Information
You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.
Birthday:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Gender:
Choose
Female
Male
Education:
Choose
Associate degree
College degree
Doctoral degree
High school
Masters degree
Some college
Trade/Vocational school
Spanish Speaking?:
Choose
No
Yes
Availability
Please indicate the days and times you are usually available to volunteer.
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Morning:
Afternoon:
Evening:
Email Preferences
We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.
What kinds of email would you like to receive?
Electronic newsletters
Recruitment appeals
Confidentiality Statement
I agree to keep confidential from outside sources all information pertaining to clients. I understand that this is privileged information.
I Agree
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