QCCB Volunteer Application

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Name
*

Gender
*

Female

Male

Non-binary

Transgender

Other:

Race/Ethnicity
*

White

American Indian or Alaska Native

Black or African American

Asian

Native Hawaiian or Other Pacific Islander

Other:

Required

County of Residence *

Candidates must be 18 years of age or older.
Birth Date (mm/dd/yyyy):
*

YYYY

Email Address *

Phone number
*

Volunteering Areas of Interest (Check all that apply) *

Community Event Planning And Support

Brand Ambassador

Amazon Smile Registrations

Partner And Sponsorship Acquisition

Marketing Campaigns (Social Media, Newsletter)

Fundraising (Private Donors)

Other:

Required

Are willing to sign a non-disclosure agreement? *

Yes

What is your weekly availability for volunteering? (Check all that apply) *

Morning

Afternoon

Evening

Mondays

Tuesdays

Wednesdays

Thursdays

Fridays

Saturdays

Sundays

List Training, Skills, Talents and Hobbies *

List Community Affiliations (Clubs, Service Organizations, etc) *

Previous Volunteer Experience *

Describe any breastfeeding/lactation related experience you have being sure to include location, role, dates, etc. (if applicable)
*

Are you willing to receive a background check? *

Yes

Are you willing to receive or show proof of receipt of the required vaccinations? *

Yes

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