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 have any questions or concerns about completing this application, please send an email to
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First Name: *
Last Name: *
Address (Street Name, City, State, Zip): *
Phone Number: *
Email: *
Date of Birth: *
Highest Level of Education Competed: *
College/Graduate School Attended: *
Degree Major(s)/Minor(s): *
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."
Employer: *
Employer's Address (Street Name, City, State, Zip): *
How did you hear about Mosaic Family Services? *
Why do you want to volunteer/intern for Mosaic Family Services? *
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."
Please list any languages, other than English, you are fluent in: *
Please indicate your availability: *
Include days of the week and times available.
Length of volunteer commitment: *
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."
Are you seeking community service hours as a result of a court issue?: *
Emergency Contact: *
Please list someone that can be contacted in case of an emergency (include name, relation, and phone number):
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