Applicant Information
First Name (required):
Middle Initial:
Last Name (required):
Birthdate (mm/dd/yyyy): (required): //
Preferred Name:
Maiden Name or AKA:
Mailing Address
Zip Code:
Home Phone: ()-
Work Phone: ()-
Cell Phone: ()-
Email (required):
  (The Volunteer Coordinator will contact you via this email address)
Church/Organization City:
How did you learn about our volunteer program?
Why are you interested in volunteering here?
Have you been convicted of a felony in the past 10 years?  Yes No
If yes, please state date & offense: //
Former Addresses

List former addresses or places of residence in the last 10 years:

Employment Information
Current/most recent Employer:
Date Employed (mm/dd/yyyy): //
Employer Address:
Zip Code:
Student Information
Current School:
Student of:

Reference not residing with you, known for at least 2 years:

Zip Code:
Phone: ()-

Please complete individual sections below based on your interests in volunteer service

Type of Volunteer
 Court Ordered Community Service
Court, Probation Office & Phone:
Offense(s) causing Community Service:
 Meal Provider
Are you able to be on the back up call list, should someone cancel or not show?  Yes No
If Yes, how much advance notice do you need?
What days do you plan to provide a meal?  1st 2nd 3rd 4th 5th
   M T W Tr F Sa Su
 Shelter Volunteer
What days/shifts are you able to volunteer?  7 p.m. - 11 p.m. 5:30 a.m. - 7 a.m.
Are you able to volunteer at the last minute should someone not show for their 7 p.m. shift?  Yes No
 General Volunteer
Name(s) & age(s) of those who might join you from your family:

To the best of my knowledge, the above information is true and is submitted voluntarily. This information may be used and disclosed for Project Hopes purposes. I realize as a Project Hope for the Homeless volunteer I am not paid for my service, and am not covered under worker's compensation. I agree to comply with all guidelines, rules, and procedures.