Gateway Community Action Partnership
Volunteer Application
Department or Position Applying For:(If unknown, type "General")

 
Street Address:

 
Name:

 
Town:

 
State:

 
Zip Code:

 
Phone Number:

 
E-mail:

 
Date of birth: (mm/dd/yyyy)

 
Emergency Contact- Name:

 
Emergency Contact- Phone:

 
If you are under 18, do you have a sponsor?*

Please note: Minors under 18 must be sponsored to volunteer by a sending organization or a parent/guardian.

Sponsor Name:

 
Sponsor Contact Number:

 

How did you learn about volunteer opportunities with Gateway?

 
Areas of interest (Please check all that apply)

 
Skills (Please Check all that apply)
Additional Comments (Skills, experience, etc)

 
Availability- How often can you volunteer?*
If you are available to volunteer regularly, how many hours can you serve each time?

 
Days and times available (Check all that apply) 
If you plan to volunteer on a regular, weekly basis with any of our childcare programs, you are required to have a physical and a Tuberculosis test and submit to a background check and fingerprinting.
If you have ever been convicted of a crime or have pending charges, please explain offense and surrounding circumstances. (This information remains confidential.)

 
Are you willing to submit to a Child Abuse Record Information and Fingerprinting Check?*
Please list two references (at least one non-relative) with current address and phone numbers.

 

 
Signature Date: (mm/dd/yyyy)

 

If under 18

Parent/Guardian/Sending Agency Signature

 
Parent/Guardian/Sending Agency Phone:

 
Parent/Guardian/Sending Agency E-mail: