Volunteer Application

Volunteer Application Information

First Name*

Middle Initial

Last Name*

Alias / Maiden Name

SS Number*

Drivers License Number

Date of Birth*

Daytime Phone

Area Code

Phone Number

Evening Phone

Area Code

Phone Number

Address:*

Street AddressCityStateZip Code

Emergency Contact Information

Name

First

Last

Relationship

Emergency Daytime Phone

Area Code

Phone Number

Emergency Evening Phone

Area Code

Phone Number

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

1/2

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?

Yes

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

2/2