Esperanza- Volunteer Application

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First and Last Name:
Home Address:
City:
State:	Zip:
Email (Personal):
Phone (Home):
Employer:
Work Address:
City:
State:	Zip:
Email (Work):
Phone (Work):
I prefer to be contacted at:
	Home Work by Email by Phone by Mail
Volunteer interests: (please check all that apply)
	Administrative Art Program Board Membership Class Assistance Finance/Accounting Fundraising Gardening	Information technology assistance Maintenance Marketing Mentoring program Special events Other
Volunteer interests by program: (please check all that apply)
	Esperanza Community Services Esperanza School Coleridge Adult Training Program Community Integrated Living Arrangement (CILA) Client and Family Support Program
I am employed:
	Full-time Part-time Retired Student
I am available:
Time:	Mornings (8-12) Afternoons (12-5) Evenings (5-9)
Days:	Monday Tuesday Wednesday Thursday Friday
Number of Hours:	per Day Week Month
Have you ever volunteered with Esperanza?
	Yes No
Optional Information
Education:
	High School/GED Bachelor's Doctorate Some college Master's
Ethnicity:
	African American Asian/Pacific Islander Caucasian Hispanic Native American Other
Gender:
	Male Female
Agreement and Electronic Signature I certify that the statements in this volunteer application are true and have been given voluntarily. If the information provided is untruthful, I understand that I will be released from the volunteer program. I realize that the information may be disclosed to any party with legal and proper interest, and that I release the agency from any liability for supplying such information. I understand that I will not be paid for my services as a volunteer, and that filling out an application does not guarantee acceptance into a volunteer position. In addition, I hereby RELEASE AND HOLD HARMLESS, Esperanza Community Services, its agents, employees, members, staff, and representatives, for whom volunteers work or are involved with, from any injuries sustained by myself , or any damage to my property while traveling to or from activities or meetings, or while on site at the activities. Hitting the Submit button below acts as my electronic signature.