Volunteer Application Form

Name

Phone

Address

Date of Birth (YYYY-MM-DD)

Grade/Year in college

School

Area of Interest/Major

Parent/Guardian Phone Number (If under 18)

Emergency Contact Phone Number (If different from above)

Which groups are you interested in and why?

Do you have reliable transportation to our clinic in Milan during group times?

Will you need documentation of your hours at the end of the summer?

Tell us why you’re interested in volunteering in our groups:

Name and phone of at least 1 personal reference & their relationship to you: