IMPACT Volunteer Interest Form Question Title * 1. Full Name Question Title * 2. Address Question Title * 3. Phone Question Title * 4. Email Question Title * 5. Emergency Contact Question Title * 6. Employer Question Title * 7. Occupation Question Title * 8. Why do you want to volunteer with IMPACT? Question Title * 9. Which weekdays are you available? M T W TH F Question Title * 10. Check all times that you are available to volunteer. 9 AM – NOON NOON - 3 PM 3 PM - 6 PM 6 PM - 9 PM Question Title * 11. Occasionally there may be volunteer opportunities on Saturdays. Would you be open to volunteering on Saturdays (if available)? (Check One) YES NO Question Title * 12. Are you currently an advocate for any other cause or agency? YES NO Question Title * 13. If yes, please list the organizations and your involvement Question Title * 14. Are you currently involved with other community-based organizations? YES NO Question Title * 15. If yes, please list the organizations and your involvement Question Title * 16. Please check all IMPACT Programs that interest you Youth Services Job Training Services Climate Justice Initiatives Home Weatherization Financial Wellness Emergency Assistance Question Title * 17. Please check all volunteer opportunities that interest you (this list is not all inclusive) Program Support Special Events Fundraising Efforts Public Speaking Canvassing Discussion Panel Income Tax Preparation Question Title * 18. Do you have any health concerns or restrictions that we should be aware of when assigning you to specific tasks? Question Title * 19. Please check all that are applicable to you (this list is not all inclusive) I am fluent in another language I can write in another language I can translate another language I can perform sign language If so, list language(s) None of the above Question Title * 20. Please check all are social media platforms that you use Facebook Instagram LinkedIn Twitter Other (please specify) Question Title * 21. Please list your special skills and/or hobbies Done
