Volunteer

First Name*
Last Name*

Your Phone Number*
(Please ensure your voicemail is set up and has space to receive new
messages.)

Your Email*
(Check your junk folder – sometimes our emails are screened out there
by mistake!)

Your Address*

Street Address*

City*

State*

ZIP*

Birthday*

Race*

American Indian or Alaskan NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhitePrefer Not to Say

Ethnic Background*

White/CaucasianAsian – EasternAsian – IndianHispanicAfrican-AmericanNative-AmericanMixed RaceOtherPrefer Not to Say

What Type of Service Hours/Length are You Interested in?*

Short-Term (single event/fundraiser/etc)Long-Term (steady days over long periods)

Volunteer Area of Interest (Check All that Apply)*

Administration/ReceptionShelter AssistanceFacilities/MaintenanceKitchenSpecial EventsKids/Youth ProgramsGardenOther

Are You Willing to Submit A Background Check?*
YesNo

Do You Have A Valid Driver’s License?*
YesNo

Do Your Own Reliable Transportation?*
YesNo

What Led You to Choose MHDCC as a Volunteer Agency?*

What Type of Schedule/Hours/Days Are You Interested In as far as Volunteer Time is Concerned?*