CENTRO LATINOAMERICANO VOLUNTEER AND INTERNSHIP APPLICATION

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* 1. Today's Date

Date / Time

Date

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* 2. Name (First Name, Middle Initial, Last Name

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* 3. Date of Birth

Date / Time

Date

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* 4. SSN

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* 5. Address

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 6. Volunteer and Internship Options

Human Services Administrative Assistant

Tabling and Outreach

Fundraising

Behavioral Health/Addictions

Fundraising

Youth Mentor

Childcare

Other

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* 7. What days are you available to volunteer

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

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* 8. Available Time(s) Of Day

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* 9. Are you 18 years or older?

Yes

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* 10. If not, how old are you?

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* 11. References - Name, Relationship, Telephone Number

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* 12. This section to be completed by intern candidates only - Enter Internship Term, Internship Year and if you are a Junior or Senior.

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* 13. Name of School

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* 14. Department of Study

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* 15. Name of direct school program supervisor

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* 16. Number of hours you are required to complete

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* 17. A $10.00 NON-REFUNDABLE FEE IS PAID DIRECTLY TO THE OREGON STATE POLICE ONLINE. VOLUNTEER AND INTERNSHIP OPPORTUNITIES ARE SUBJECT TO THE SUBMISSION OF A BACKGROUND CHECK. YOU MAY PAY $10 AT CENTRO'S FRONT DESK AND WE WILL REQUEST YOUR BACKGROUND CHECK TO THE OSP

Acknowledge

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* 18. How did you hear about Centro Latino Americano

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* 19. Educational Background And volunteer Experience

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* 20. Social justice background and experience

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* 21. Spanish speaking, writing and/or reading abilities

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* 22. Any other skills you would like us to know about

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* 23. Other clubs or organizations in which you are currently active

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* 24. Describe your experience with people of cultural or socioeconomic background different that your own.

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* 25. Why do you want to volunteer at CentroAmericano

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* 26. What would you like to learn form this expereince

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* 27. Please describe any experience you might have in fundraising and special events

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* 28. Background Check

I hereby authorize Centro Latino Americano and its designated agents and representatives to use my personal information to request a background check