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.