Volunteer Application - Daily Planet Health Services

Name

Date of application

Address

City/State/Zip

Day Telephone

Night Telephone

Email Address

Best time to reach you

Have you received services from Daily Planet in the last year?

Work History

List most recent volunteer experience

Are you a student?

If yes, school name

If in college, what is your major?

If no, please list highest level of education

Name of school (highest level completed)

Affiliations with local congregations/civic organizations

Hobbies/Interests

Skills/Language

Please list any special skills (computer, financial literacy, research) and/or additional language(s) you speak.

Why are you interested in volunteering at Daily Planet?

How did you find out about Daily Planet?

If "other" please explain:

At which location(s) would you be interested in volunteering?

Volunteer Interests at West Grace Health Center

Administrative/Office Work

Healthcare Clinic

Dental Clinic

Website/Social Media

Volunteer Interests at Southside Health Center

Administrative/Office Work

Healthcare Clinic

Medical Respite

Please note this is an off-site location, transportation is required.

Expected length of commitment

Number of hours to volunteer per week

We prefer volunteers to commit to a minimum of 4 hours per week.

List the day(s) and time(s) you are available to volunteer below:

Please note: volunteer opportunities are Monday through Friday from 8am to 4:30pm. At this time, we do not have volunteer opportunities in the evenings or on the weekends.