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.




Check the appropriate checkbox for your experience

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



Reason for applying?

If your reason or desired volunteer experience is not listed, and you have other skills you would like to share with us, please share a short paragraph in the box below.



Edu or field of study (Interns/Practicum only)


Prof./Instructor information (Interns & Practicum)

You will need to provide a course syllabus to your Internship Supervisor.



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 .



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.



Availability - Dates/Hours

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



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.





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.