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:

City:

Zip:

Home phone:

* OK to call me here

Email address:

Date of birth:

* (year optional)

Age:

Gender:

Education:

School:

Interested in serving on the Board:

Employer name:

Title:

Why are you interested in volunteering? (Retired, student community service, TAPS program, court ordered community service, etc.)

Emergency Contact

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

First name:

Last name:

City:

Zip:

Home phone:

* OK to call here

Relationship:

Are there any limitations or medical problems that we should be aware of?

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

Relationship:

Are you involved in any local clubs or groups?

Volunteer Preferences

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

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.

What kinds of email would you like to receive?

Electronic newsletters

Recruitment appeals