Volunteer Application for White Bear Area Senior Program
2484 East County Road F
White Bear Lake, MN 55110
651-653-3121
www.whitebearseniorprogram.org
Name (First, Last)
Your answer
Best phone number to reach you
Your answer
Home Address
Your answer
City
Your answer
State, Zip
Your answer
Email
Your answer
Where did you hear about the Senior Volunteer Program?
Your answer
Why are you interested in volunteering for our program?
Your answer
Previous volunteer or work experience?
Your answer
Do you have any limitation that might limit your volunteering?
If you answered YES to the above question, please explain.
Your answer
Areas of Volunteer Service
Please indicate the areas you are interested in.
Senior Center Opportunities
What mornings are you available to volunteer?
What afternoons are you available?
Time available to volunteer
Reference #1 - Name and phone number
Your answer
Reference #2 - Name and phone number
Your answer
Emergency Contact - Name and phone number
Your answer
Matching Gift Program: Does your company participate in a Matching Gift Program for volunteer work?
The above information is correct to the best of my knowledge. I understand that this form is confidential and its contents will not be released to anyone without my written consent, with the exception that references will be made aware of my volunteer position application. I agree to notify the White Bear Area Senior Program of any changes in the above information.
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