VolunTEEN Services Application Form

Fields with an * are required

Personal Information

* First Name:
* Last Name:
* Email Address:
Age:
Date of Birth:
Month Day Year
Phone:
Cell Phone:

Address

* Address:
Address 2:
* City:
* State:
* Zip Code:

Parents/Guardians

Name:
Address:
Address 2:
City:
State:
Zip Code:
Home Phone:
Work Phone:
   
Name:
Address:
Address 2:
City:
State:
Zip Code:
Home Phone:
Work Phone:

Education

School:
Grade:
Guidance Counselor:
Extracurricular Activities:

Volunteer Interests

Why do you want to be a VolunTEEN?
Skills and/or Hobbies:
Campus Preference:

Please Read and Acknowledge The Following Statement:

I authorize investigation of all statements contained in this application; I understand that misrepresentation of omission of facts called for is sufficient cause for dismissal. In addition, I authorize SH to perform the required PPD tests for tuberculosis. Cost is covered by SH.)