Adult Volunteer Application

Last Name	First Name				Date of Birth
Address q Home q Work			City & State				Zip Code
E-mail Address		Home Phone		Work Phone		Other Phone
Current Employer		Title

Licenses, Degrees & Certifications? Please List

Office/Computer Skills? Please List

Professional Skills? Please List

Fluency In Other Languages? Please List

Other Skills or Talents? Please List

How would you like to contribute to Positive Images? ____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Do you volunteer or work with any other organizations? If yes, please list.

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

When would you be free to Volunteer? Please list Times							How often would you like to Volunteer?
Mon	Tues	Wed	Thurs	Fri	Sat	Sun	q Once a Week	q Twice a Month
Start	Start	Start	Start	Start	Start	Start	q Once a month	q Special Events
End	End	End	End	End	End	End	q Other:

Please Return Application To:

Positive Images

312 Chinn St.

Santa Rosa, CA 95404

Phone/Fax: (707) 568-5830

E-mail: posimage@sonic.net

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