Survey - Volunteer Interest Form - Your Community

Thank you for your interest in volunteering with Outreach International - we appreciate your desire to serve. Please complete the interest form below, and we will respond as soon as possible.

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Name:

First Required	Last Required

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Email: Required

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Street 1: Required

Street 2:

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City/State/ZIP:

City Required	State Required	ZIP Required

Hooray! You'll receive occasional email updates from Outreach International about the good things your support makes possible.

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Question - Required - My schedule will allow me to volunteer (check one):

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Question - Required - How did you find out about Outreach International?

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Question - Required - I'm interested in volunteering for Outreach in my own community or region as a:

	Service Volunteer: I have limited time but can help with a fundraiser or event
	Volunteer Representative: I can commit 3 hrs/month in my area to advocate and fundraise
	Volunteer Advisor: I want to serve as an advocate, mentor and coordinator for volunteers state-wide and can commit to 5 hrs/month

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Question - Required - Are you looking for a volunteer opportunity to fulfill service hours?

Question - Not Required - If you answered "Yes" above, please provide us with the name of your organization, the number of hours you need to complete, and your deadline.

Question - Not Required - Anything else you want us to know? Special interests and skills? Previous volunteer experience?

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Question - Required - I verify that the information I have supplied on this interest form is true and complete. I agree to conform to Outreach International's rules, regulations and policies. I release and agree to hold Outreach International, its staff, Board of Directors and officers, harmless from all liability, which might result from an injury while participating in agency volunteer activities. I understand that upon review of my completed application, I will be contacted by a staff person from Outreach International for an interview. I also understand that volunteer orientation or training may be required.