Poe Center Volunteer Application
Thank you for your interest in volunteering at the Poe Center! We value your contribution of time and resources. Your first step to becoming a Poe Center Volunteer is to complete the application information below. New volunteer orientations are held monthly at the Poe Center. For questions about volunteering at Poe, please contact Thomas at t.ray@poehealth.org.
First Name
Your answer
Last Name
Your answer
Birth Month
Birth Date
Birth Year
Street Address
ex. 224 Sunnybrook Road
Your answer
Street Address Continued
Apartment or Suite Number, etc.
Your answer
City
ex. Raleigh
Your answer
Zip Code
Your answer
Phone Number
Please include area code
Your answer
Other Contact Phone Number
Please include area code
Your answer
Email Address
Your answer
Referring School or Organization, if applicable
Please include the address of the school or organization.
Your answer
Grade Level
Referring Instructor Contact Name
Your answer
Referring Instructor Contact Information
Best email or phone number for reaching your referring instructor.
Your answer
Emergency Contact Name
Your answer
Emergency Contact Phone
This MUST be a phone number where your emergency contact can be reached.
Your answer
Volunteer Experience
Please describe in 250 words or less your previous volunteer experience(s).
Your answer
Days and Times and Duration of Availability
Please describe the days and times you are available to volunteer as well as the length of your volunteer time.
Your answer
Other Community Activities/Ongoing Responsibilities
Include any jobs/volunteering along with your hourly commitment to each.
Your answer
Why do you want to be a Poe Center Volunteer?
Describe what about Poe motivates you to want to be on our team?
Your answer
Please describe what you can bring to the Poe Center.
List talents, skills or interests you have that would benefit Poe.
Your answer
Goals
Please describe three (3) goals that you hope to achieve by the conclusion of your volunteer experience at Poe.
Your answer
Orientation Availability
Please identify time of day that you are available for a volunteer orientation.
Required
Please select your areas of volunteer interest. See the volunteer webpage for position descriptions.
Please check all that apply.
Required
Program or Course or other Mandatory Requirement?
Please indicate whether your volunteerism is required for program, course, or otherwise mandatory.
If you are 18 years of age or older, do you give the Poe Center permission to complete a background check?
If you are under 18, please select "Not Applicable."
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