College Volunteers - Application

Volunteer Application - College

Personal Information
First Name:	Last Name:		MI
Home Address:	City:	State:	Zip:
Telephone:	Mobile Phone:
E-mail:	Birth Date: (MM/DD/YYY)
Major:	Year in School
Briefly explain why you would like to volunteer:
Emergency Contact Information (Please provide a local address & phone number)
Name:	Relation:
Phone:
Preferences
Services in which I may have an interest in volunteering:	ACU Diagnostic Imaging ER
Day of Week Preferred (check all that you would consider):	Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Time of Day Preferred (check all taht you would consider):	Morning (9a-Noon) Afternoon (Noon-3p) Evening (3p-6p) Late Evening (6p-9p) Midnight (9p-Midnight)
Background
Have you ever been convicted or received a deferred sentence for a felony offense?	Yes No