Salt Lake CAP Head Start
 






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Volunteer Application

Date: Nov 20th, 08 Male: Female:
Name: Date of Birth:
Address: City: State: Zip:
Home Phone: Work Phone: Cell Phone:
E-mail: Languages Spoken: Employer:
Phone: Position:

Please list two personal references: (other than family members)
  Name Address City/State/Zip Phone
1
2

Have you ever been convicted of a criminal offense (misdemeanor or felony): Yes
No
Date of Conviction:
Name/Address of Court: Nature of Offense:

When are you available to volunteer? (enter time of day)
  Monday Tuesday Wednesday Thursday Friday Saturday
Morning
Afternoon
Evening

How often would you like to volunteer? Weekly Monthly

Please check the area in which you would like to volunteer.
Classroom Reader Classroom Activities Translation, Interpreter
Office Assistant Computer Lab Aide Building Fix-up & Repair
Parent Trainer Head Start Activities Other

List other groups or organizations to which you belong.

How did you hear about Head Start?


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