Mosaic Volunteer Application
We require all volunteers and interns to complete a volunteer application, attend a volunteer orientation, and pass a background check. Please complete the online application and Mosaic's Volunteer Coordinator will be in touch soon.

If you are interested in Mental Health Counseling volunteering services, DO NOT fill out this application, please inquire with Claudia D'Avila at ClaudiaD@mosaicservices.org.

If you have any questions or concerns about completing this application, please send an email to volunteer@mosaicservices.org.

First Name: *
Your answer
Last Name: *
Your answer
Address (Street Name, City, State, Zip): *
Your answer
Phone Number: *
Your answer
Email: *
Your answer
Date of Birth: *
MM
/
DD
/
YYYY
Highest Level of Education Competed: *
Required
College/Graduate School Attended: *
Your answer
Degree Major(s)/Minor(s): *
Your answer
Will you receive educational credit for your service hours? If yes, how many hours are needed in total and by what date should they be completed?: *
Otherwise, put "N/A."
Your answer
Employer: *
Your answer
Employer's Address (Street Name, City, State, Zip): *
Your answer
How did you hear about Mosaic Family Services? *
Required
Why do you want to volunteer/intern for Mosaic Family Services? *
Your answer
Please check the volunteer opportunities you are interested in: *
You also have the option to develop your own volunteer services with Mosaic. If so, please describe below in "Other."
Required
Please list any languages, other than English, you are fluent in: *
Your answer
Please indicate your availability: *
Include days of the week and times available.
Your answer
Length of volunteer commitment: *
Required
Have you ever been convicted of a criminal offense? If yes please state the nature of the crime(s), when and where convicted and the dispositions of the case: *
Otherwise, put "N/A."
Your answer
Are you seeking community service hours as a result of a court issue?: *
Required
Emergency Contact: *
Please list someone that can be contacted in case of an emergency (include name, relation, and phone number):
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of MOSAIC FAMILY SERVICES INC. Report Abuse - Terms of Service