Volunteer Application
Dimitri House is a nonprofit organization built on the belief that every human being has immeasurable value. We serve those in need in the Rochester community by offering a range of programs including food, shelter, and services that help them on their journey toward self-sufficiency.
Email address *
First Name *
Your answer
Last Name *
Your answer
Date of Birth
MM
/
DD
/
YYYY
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone
Your answer
Mobile Phone
Your answer
Emergency Contact Name (ECN) *
Your answer
Relationship
Your answer
ECN Phone *
Your answer
ECN Mobile Phone
Your answer
Employer
Your answer
Location
Your answer
Position Held / Job Title
Your answer
Employment Start Date
MM
/
DD
/
YYYY
Employment End Date
MM
/
DD
/
YYYY
Please list any special training, skills, or hobbies that you have.
Your answer
Please list any groups, clubs, or organizations that you belong to.
Your answer
Why do you want to volunteer at Dimitri House?
Your answer
How did you learn about Dimitri House?
Your answer
What days are you available?
What times are you available?
Which program(s) interest you?
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy