Micah's Place Volunteer Application

Completing this application form is the first step to get involved at Micah's Place & Purple Dove. Once you complete the form, click the Continue button at the bottom.

About You

Tell us a bit more about yourself so we can provide the best volunteer placement possible.

First name:

Last name:

Street 1:

Street 2:

Street 3:

City:

State:

Zip: *

Home phone:

* OK to call me here

Work phone:

OK to call me here

Email address:

Date of birth:

Age:

Gender:

Education:

School:

Employer name:

Title:

Emergency Contact

Please provide information on who we should contact in the case of an emergency.

First name:

Last name:

City:

State:

Zip:

Home phone:

* OK to call here

Work phone:

OK to call here

Email address:

Relationship:

Are there any medical problems or issues of which we should be aware in the event of an emergency?

Personal References

Provide at least one personal reference.

1

2

First name:

Last name:

Home phone:

OK to call here

Home phone:

OK to call here

Cell phone:

OK to call here

Cell phone:

OK to call here

Email address:

Relationship:

Volunteer Preferences

Please indicate the days and times you are usually available to volunteer, your skill set, and preferred assignment(s).

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

My availability is:

From:

to:

* Assignment Preference:

Resale Center Volunteer [Callahan - Purple Dove Resale Center\Volunteer Services]

Resale Center Volunteer [Yulee - Purple Dove Resale Center\Volunteer Services]

Please list any volunteer work, special training, skills, special interests and other activities that may be useful to your volunteer placement:

Communication Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email. Use the checkboxes below to select your communication preferences.