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VITA West Michigan Volunteer Application
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Middle initial
Your answer
Volunteer Last Name
*
Your answer
Home Address (Street Number and Name, Rural Route, PO Box)
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Email Address:
Your answer
Cell Phone
Your answer
Texting?
Yes
No
Clear selection
Home Telephone Number
Your answer
Ottawa or Kent County?
*
Ottawa County
Kent County
Either
Both
Required
Birth Date (mm/dd/yyyy)
MM
/
DD
/
YYYY
Gender
*
Your answer
Race
*
American Indian
Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
International Student and One the selected item(s) above
I prefer not to say
Other:
Required
Ethnicity
*
Your answer
Language(s) spoken:
Your answer
Person to Notify in Case of Emergency
Your answer
Emergency Contact Phone Number
Your answer
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