Date of Birth* Must be 21 years of age to volunteer
- Month - January February March April May June July August September October November December
- 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 - Female Male Non-Binary Prefer not to answer
- State - Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
- State - Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Does your place of business have any of the following? Check all that apply.
May someone from Lawrence Hall contact you about these opportunities?
Do you agree to submit to a background check?*
Have you ever been convicted of a felony outside of a minor traffic violation?*
Have you ever been employed or otherwise participated in programming at Lawrence Hall in the past (i.e. alumni)?*
How did you hear about our volunteer program?*
- Choose one - Church Bulletin Employer Friend Newspaper/Newsletter Lawrence Hall Employee/Volunteer Radio Volunteer Fair Lawrence Hall Website Other Website (Please Specify Below) Other Source (Please Specify Below)
Please list your current or past volunteer affiliations
What volunteer opportunities are you interested in at Lawrence Hall?
- Choose one - Clerical Work Corporate Volunteer Day Fundraising activities Special events Lawrence Hall Auxillary Junior Board Mentor Tutor Workshops Culinary arts Other (please specify below)
Why are you interested in becoming a volunteer with Lawrence Hall?*
What is your availability?*
Emergency Contact
Person to contact in case of emergency
Emergency Contact Relationship
References
Please list THREE (3) personal references (other than family members) that you have known for at least three years:
All volunteers are required to submit an Authorization for Background Check to the Department of Children and Family Services. Please provide the last four (4) digits of your Social Security number (SSN) for Lawrence Hall Youth Services to initiate this process:
SSN Number Last 4 Digits*:
I understand that the information and references supplied on this application will be checked and verified by Lawrence Hall. All information obtained will be held in strict confidence, and will be shared only with the Lawrence Hall staff that have direct responsibility to the child/children that I will be working with as a volunteer.
I release all parties from any liability or responsibility in granting and furnishing such information.
Signature*:
Date*:
