Volunteer Application Please enable JavaScript in your browser to complete this form.Name *FirstLastDate of Birth *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Date Available to Begin *OccupationDays/Times Available to Volunteer *Emergency Contact *Emergency Contact Phone *Please list any previous volunteer experience. *What interests you in volunteering with UCHM? *Have you ever been convicted or plead guilty to a crime? (Background check required) *YesNoIf you answered yes to the previous question, please explain:Personal Reference #1 *FirstLastPhoneEmail *Personal Reference #2 *FirstLastPhoneEmail *Personal Reference #3 *FirstLastPhoneEmail *I am interested in volunteering in the following areas: *United Learning Day ProgramUnited Learning After-school ProgramSenior Community MealsMeals on WheelsFood PantryUtility AssistanceDonation Pick-UpYoung Scholars ProgramOtherWould you like to sign up for our newsletter to stay up to date on new volunteer opportunities?Applicant StatementThe information contained in this application is correct to the best of my knowledge. I authorize any references listed on this application to release any information that they may have regarding my characterand fitness to work in a volunteer capacity. I release any individual, group, or agency, both individually and collectively, from any liablity because of compliance or attempts to comply with this authorization. Should I be accepted, I agree to be bound by the bylaws and policies of United Crescent Hill Ministries and its programs. I further state that I have carefully read and understand the foregoing release and I sign this release of my own free act. Name *FirstLastDate / Time *WebsiteSubmit