Volunteer Application
Become a volunteer with CHAC Family Resource Centers (A CHAC program funded by FIRST 5)

Please fill out the following information.
If you have any question, please send an email to Nancy Doan, Volunteer Coordinator at nancy@chacmv.org

Hi, what is your name?
(first & last)
Your answer
Birthday
(month & day)
Your answer
Home Mailing Address
Your answer
City
Your answer
Contact Number
000-000-0000
Your answer
Email Address
Your answer
What is the best method to contact you?
(check all that apply)
What is your age range?
What language(s) do you speak?
Your answer
How did you hear about the volunteer program?
Your answer
Why are you interested in becoming a volunteer for our program?
Your answer
What skills, interests, and hobbies do you enjoy?
Your answer
How long of a time commitment can you make to the program?
How many hours per month are you available to help?
Time availability - please check the times that you are avaliable
Our office hours are typically Monday - Friday from 10 - 4 PM.
Mornings (9 - 12)
Afternoons (12 - 4)
Evenings (4 - 8) please keep in mind that we do not have many evening events
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday (please keep in mind that we do not have many weekend events)
Additional availability comments
Your answer
I am a student and I need hours for my class
Class Name / Hours Required / Hours Due By
Your answer
Are you a CHAC Trainee or CHAC Intern?
If applicable, please select one
I am interested in volunteering for the following:
(Please check all that apply)
What qualities do you think that you can bring to the team?
Your answer
What else would you like us to know about you?
Your answer
Is there any medical or disability related issues that would affect your ability to perform the job?
Additional Comments
Your answer
Referance
Name
(first & last)
Your answer
Contact Number
Your answer
Relationship
Your answer
Please Read and Sign
I am applying for a volunteer assignment with CHAC Family Resource Centers (a CHAC program, funded by FIRST 5). Permission is hereby given to Community Healthy Awareness Council (CHAC) to contact the references named above, as part of the Agency’s screening process.

I have answered the questions above truthfully and to the best of my ability.

I agree to complete the Live Scan Fingerprinting as required.

I agree to submit a TB clearance as required.

I further understand that as a volunteer, I must: (1) attend volunteer orientation and monthly trainings as necessary (2) fulfill the responsibilities of the volunteer position as specified in the job description; and (2) work in ongoing consultation with the Volunteer Coordinator and Community Workers.

Electronic Signature
Submit
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