First Name*

Middle Initial

Last Name*

Date of Birth*
Must be 21 years of age to volunteer

Month

Day

Year

Gender

Preferred Contact HomeBusiness

Home Address
Street Address

City

State

Zip

Phone

Your Email*

Business Address
Business Name

Position

Street Address

City

State

Zip

Phone

Your Email

Does your place of business have any of the following? Check all that apply.
Employee matching gift programVolunteer Awards programCompany FoundationOther corporate giving opportunities

May someone from Lawrence Hall contact you about these opportunities?
YesNo

Do you agree to submit to a background check?*

Have you ever been convicted of a felony outside of a minor traffic violation?*

If yes, please explain:

Have you ever been employed or otherwise participated in programming at Lawrence Hall in the past (i.e. alumni)?*

If yes, please explain:

How did you hear about our volunteer program?*

If Other:

Please list your current or past volunteer affiliations

What volunteer opportunities are you interested in at Lawrence Hall?*

If Other:

Why are you interested in becoming a volunteer with Lawrence Hall?*

What is your availability?*
DaysEveningsWeekends

Person to contact in case of emergency
Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Please list THREE (3) personal references (other than family members) that you have known for at least three years:

Character Reference 1

Name

Relationship

Character Reference 2

Name

Relationship

Character Reference 3

Name

Relationship

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*:
Please type your full name.

Date*:
Please type today's date. (MM/DD/YYYY)

By clicking "submit," you will complete and send the application online.