Imajine Me Volunteer Interest Application
                                                  ~*~ Invision....Inspire....Inlighten ~*~
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אימייל *
Name: *
Date of Birth: *
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Street Address: *
City, State, Zip: *
Phone: *
Emergency Contact (please list name and phone number for each):
 *
Have you ever pled guilty or been convicted of any crime(s)? *
Have you ever been denied participation to volunteer with any youth programs? *
Have you ever been required to register as a sex offender under any federal or state statute? *
If you answered "yes" to any of the above questions, please provide complete details below: *
Do you have reliable transportation?
 *
Do you have experience mentoring or working with teens and/or young adults? *
In your own words, please tell us why you are interested in volunteering with Imajine Me: *
Are you comfortable working with teen and/or single parents, as well as their families? *
What is your availability to volunteer?  Please list days and times available:   *
From the following section, please select the areas that interest you: *
חובה
I certify that all statements made on this application are accurate and true.  I acknowledge that if selected as a volunteer candidate for Imajine Me, I will abide by all policies and procedures of the organization.  I understand that I will volunteer at my own risk and that the organization and its affiliates, cannot assume responsibility for any accident, injury, or health issue that may arise from any volunteer work I perform.  I further understand that as a volunteer, monetary gain will not take place.
 *
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