Volunteer Application Information

First Name*
Middle Initial
Last Name*
Alias / Maiden Name
Social Security Number*
Drivers License Number
Date of Birth*
Daytime Phone
-
Evening Phone
-
Address:*

Emergency Contact Information

Name
Relationship
Emergency Daytime Phone
-
Emergency Evening Phone
-

I, the undersigned applicant, grant permission for Gateway Homeless Coalition, Inc. to receive my criminal information regarding any criminal charges, past, and / or pending.

Electronic Signature*
Date
Please Describe your previous Volunteer Experience
What is your desired weekly commitment?
What are your areas of interest for volunteering with us?
Are you computer literate? If so, please list the programs in which you are proficient.
Please list any other relevant skills.
Are you a student?

If yes, please answer the following:  

Major
Expected Graduation Date:

CONFIDENTIALITY AGREEMENT

I, the undersigned applicant, promise to keep confidential all information regarding residents of Gateway Homeless

Coalition, Inc. I further agree not to disclose any information ab out shelter business and activities. Any and all

unauthorized review, use and disclosure or distribution of confidential information is prohibited. Gateway Homeless

Coalition, Inc. prohibits discrimination on the basis of race, color, religion, sex, national origin, sexual orientation or

gender identity, ancestry, age, disability or veteran status.


Signature*
Type these letters into the field below:
Todays Date