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311 South Lincoln Street, P. O. Box 1716

Bloomington, IN 47402

Phone: (812) 332-5311 Fax: 332-9750

VOLUNTEER STAFF APPLICATION

ELIGIBILITY: Please note that Volunteer Staff must be 18 or older AND pass an annual criminal background check. Volunteer hours at the Club WILL NOT be applied towards mandated community service.

LEGAL NAME (INCLUDING MIDDLE) _________________________________ DATE (MM/DD/YY)__________________

FULL LOCAL ADDRESS (Include Zip)__________________________________________________________________

LOCAL PHONE NUMBER _________________________ PREFERED NAME FOR NAME TAG:_____________________

E-MAIL ADDRESS_________________________________________________________________________________

EMERGENCY CONTACT________________________________    &    PHONE NUMBER _________________________

ARE YOU VOLUNTEERING FOR A SERVICE-LEARNING CLASS?         YES        NO


IF SO, WHAT SCHOOL, COURSE AND INSTRUCTOR _____________________________________________________

EDUCATION:

SCHOOLS                CITY, STATE             MAJOR AREA                          GRADUATION OR EXPECTED

                                             OF STUDY                            GRADUATION DATE

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OTHER TRAINING/ CERTIFICATIONS:

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EMPLOYMENT AND VOLUNTEER WORK:

DATES                NAME OF EMPLOYER OR ORGANIZATION            POSITION        REASON FOR LEAVING ____________________________________________________________________________________

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COMMITMENT: BGCB Volunteer Staff commit to a minimum of two consistent shifts per week for a commitment of 4-5hrs/wk. For the fall semester, volunteers are scheduled from Sept-Dec and for the spring semester, volunteers are scheduled for Jan-May, taking into consideration the Indiana University and Monroe County Community School Corporation calendars.

AVAILABILITY:        DAY ONE (CIRCLE):        M        T        W        TR        F

        

DAY ONE SHIFT (CIRCLE):         3:00-5:15        4:00-6:00         5:00-7:00        

DAY TWO (CIRCLE):        M        T        W        TR        F

        

DAY TWO SHIFT (CIRCLE):         3:00-5:15        4:00-6:00         5:00-7:00

 

DAY THREE (CIRCLE):        M        T        W        TR        F

        

DAY THREE SHIFT (CIRCLE):         3:00-5:15        4:00-6:00         5:00-7:00

PLEASE COMPLETE THE OTHER SIDE OF THIS FORM

PLACEMENT:        PLEASE RANK YOUR TOP 3 PREFERRED CLUB PROGRAM AREAS IN ORDER OF INTEREST WITH 1 BEING MOST INTERESTED AND 3 BEING LEAST INTERESTED*:

___SPORTS AND FITNESS                ___ TEEN PROGRAMMING

___VISUAL OR PERFORMING ARTS        ___ TECHNOLOGY/ COMPUTER LAB                 

___HEALTH LIFESYLES                        ___ TRANSPO/ BUS MONITOR

___EDUCATION AND CAREER                 ___ SOCIAL RECREATION/ GAMES ROOM

___MEMBERS WITH SPECIAL NEEDS        ___ OTHER _______________________

*Please be aware that Club staff consider areas of greatest need in addition to volunteer interests when creating schedules. Rankings help Club staff to determine interest areas, but do not guarantee placement in a certain area.

WHAT WOULD YOU LIKE TO LEARN THIS SEMESTER? IN WHAT AREAS WOULD YOU LIKE TO GROW PERSONALLY OR PROFESSIONALLY?

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DO YOU HAVE SKILLS OR EXPERTISE THAT YOU WOULD LIKE TO SHARE WITH MEMBERS? ARE THERE PARTICULAR PRORGRAMS YOU’D LIKE TO LEAD OR TEACH? PLEASE DESCRIBE:

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OTHER FEEDBACK OR PERTINENT INFORMATION YOU WOULD LIKE TO SHARE:

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I WOULD BE WILLING TO ATTEND A VOLUNTEER ORIENTATION (DATES TBD)                YES / NO

Thank you for your interest in becoming a member of the BGCB Volunteer Staff team!.

 For more information or with questions please contact the Volunteer Coordinator at lsvolunteercoordinator@bgcbloomington.org or 812 332 5311 x220.