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Your First Name *

Your Last Name *

Street Address *

City *

State *

Zip Code *

Cell Phone *

Home Phone

Preffered method of communication * Please ChooseEmailCell PhoneHome Phone

Date of Birth * Month/Day/Year

Current Employer/School *

Who is your immediate supervisor/ Boss / Teacher * Please include their name and Phone number, and your relationship to them

Please list two references, Please include their names and Phone number and your relationship to them. * You will not be able to volunteer without listing two refrences.

I would like to help out in other ways. Check all that apply

• I could film Holocaust survivors
• I'm a photographer
• I'm great at helping with events
• I'm great at social media
• PR is what I do best
• I'm a great web designer
• Other:

My Hobbies are * Knit, Like art, Talk Politics, Listen to music, Draw etc.

My Educational Backround *

I am Available to volunteer * Check all that apply

• Monday
• Tuesday
• Wednesday
• Thursday
• Friday
• Saturday
• Sunday
• AM
• PM

I Can Speak * Check all that apply

• English
• Yddish
• Hebrew
• French
• Spanish
• Italian
• German
• Portuguese
• Other:

How much time are you willing/able to commit to your volunteer responsibilities? *

• Once a week
• More than once a week

Please list any prior volunteer experience. Helped in a Soup Kitchen, Worked in a dog shelter...

Why are you interested in volunteering with Connect2? *

How did you learn about connect2 *

Any other input / feedback

Do you have any record of any arrests, criminal charges or convictions? * Please ChooseYesNo

Profile Certification and Acknowledgement By filling this form I confirm that to the best of my knowledge the above information is true and is submitted voluntarily. I understand that any false statement, misrepresentation or omission may cause my dismissal from volunteer services. This information may be used and disclosed for iVolunteer purposes and I realize as a volunteer I will not be paid for my services.

Date * Month/Day/Year

Signature * First and Last Name