Calcutta House Volunteer Application

Name

Date of Birth

Email Address

Address

City

State

Zip Code

Phone (home)

Phone (work)

Emergency Contact Phone

Please describe why you are interested in volunteering with Calcutta House.

Skills and Interests

Educational Background: (indicate the highest level completed and degrees earned, if any).

Current Occupation and Employer

Hobbies, Interests, Skills

Previous Volunteer Experience

Do you have any experience working with persons with AIDS or with an agency that provided service to persons with AIDS?

Availability

At what times are you interested in volunteering?

I Am Flexible
Prefer Weekdays
Prefer Weekends
There Are Times During A Week When I Cannot Do Volunteer Work.

Are there any medical or other limitations to the work you can do?

References

How did you hear about Calcutta House?

List name, address, and phone number of two references, other than relatives. If possible please include one reference from a previous volunteer experience or community activity.

Name

Phone

Address

Name

Phone

Address