CENTRO LATINOAMERICANO VOLUNTEER AND INTERNSHIP APPLICATION Question Title * 1. Today's Date Date / Time Date OK Question Title * 2. Name (First Name, Middle Initial, Last Name OK Question Title * 3. Date of Birth Date / Time Date OK Question Title * 4. SSN OK Question Title * 5. Address Name Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number OK Question Title * 6. Volunteer and Internship Options Human Services Administrative Assistant Tabling and Outreach Fundraising Behavioral Health/Addictions Fundraising Youth Mentor Childcare Other OK Question Title * 7. What days are you available to volunteer Monday Tuesday Wednesday Thursday Friday Saturday Sunday OK Question Title * 8. Available Time(s) Of Day OK Question Title * 9. Are you 18 years or older? Yes No OK Question Title * 10. If not, how old are you? OK Question Title * 11. References - Name, Relationship, Telephone Number OK Question Title * 12. This section to be completed by intern candidates only - Enter Internship Term, Internship Year and if you are a Junior or Senior. OK Question Title * 13. Name of School OK Question Title * 14. Department of Study OK Question Title * 15. Name of direct school program supervisor OK Question Title * 16. Number of hours you are required to complete OK Question Title * 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 OK Question Title * 18. How did you hear about Centro Latino Americano OK Question Title * 19. Educational Background And volunteer Experience OK Question Title * 20. Social justice background and experience OK Question Title * 21. Spanish speaking, writing and/or reading abilities OK Question Title * 22. Any other skills you would like us to know about OK Question Title * 23. Other clubs or organizations in which you are currently active OK Question Title * 24. Describe your experience with people of cultural or socioeconomic background different that your own. OK Question Title * 25. Why do you want to volunteer at CentroAmericano OK Question Title * 26. What would you like to learn form this expereince OK Question Title * 27. Please describe any experience you might have in fundraising and special events OK Question Title * 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 OK DONE