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Volunteer Interest Form
First Name:
Last Name:
Sex:
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Date of Birth (MM/DD/YYYY):
Race/Ethnicity:
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Street Address:
City:
State:
Alabama (AL)
Alaska (AK)
Arizona (AZ)
Arkansas (AR)
California (CA)
Colorado (CO)
Connecticut (CT)
Delaware (DE)
District of Columbia (DC)
Florida (FL)
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Hawaii (HI)
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Iowa (IA)
Kansas (KS)
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Maine (ME)
Maryland (MD)
Massachusetts (MA)
Michigan (MI)
Minnesota (MN)
Mississippi (MS)
Missouri (MO)
Montana (MT)
Nebraska (NE)
Nevada (NV)
New Hampshire (NH)
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New York (NY)
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North Dakota (ND)
Ohio (OH)
Oklahoma (OK)
Oregon (OR)
Pennsylvania (PA)
Rhode Island (RI)
South Carolina (SC)
South Dakota (SD)
Tennessee (TN)
Texas (TX)
Utah (UT)
Vermont (VT)
Virginia (VA)
Washington (WA)
West Virginia (WV)
Wisconsin (WI)
Wyoming (WY)
Zip Code:
Email Address *:
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Telephone:
Cellular Phone:
Work phone:
Campus Address:
Campus Address - City:
Campus Address - State:
Alabama (AL)
Alaska (AK)
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California (CA)
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Delaware (DE)
District of Columbia (DC)
Florida (FL)
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Hawaii (HI)
Idaho (ID)
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Indiana (IN)
Iowa (IA)
Kansas (KS)
Kentucky (KY)
Louisiana (LA)
Maine (ME)
Maryland (MD)
Massachusetts (MA)
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Missouri (MO)
Montana (MT)
Nebraska (NE)
Nevada (NV)
New Hampshire (NH)
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New York (NY)
North Carolina (NC)
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Ohio (OH)
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Oregon (OR)
Pennsylvania (PA)
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Tennessee (TN)
Texas (TX)
Utah (UT)
Vermont (VT)
Virginia (VA)
Washington (WA)
West Virginia (WV)
Wisconsin (WI)
Wyoming (WY)
Campus Address - Zip Code:
Volunteer Opportunities:
Mentoring
Tutoring
After-school programs
Office Tasks
Special Events
Preferred Grade Level:
K-3
4-6
7-8
9-12
Preferred gender:
Male
Female
None
Preferred location:
None
Arcadia Elementary
Edison Environmental Science Academy
King-Westwood Elementary
Lincoln International Studies School
Milwood Elementary
Parkwood-Upjohn Elementary
Spring Valley Center for Exploration
Washington Writers' Academy
Woods Lake Elementary
Hillside Middle School
Linden Grove Middle School
Maple Street Magnet
Milwood Magnet
Kalamazoo Central High School
Loy Norrix High School
Strengths:
Math
Science
Computers
Reading
Writing
Languages spoken other than English:
Do you have transportation?:
Yes
No
Educational Background:
Does this class count towards class credit? If so, list instructor and course.:
Yes
No
Instructor:
Course:
Current employer:
Current Occupation:
Please list any previous volunteer involvement.:
Reference Name (other than a relative) *:
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Street Address for Reference 1 *:
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City for Reference 1 *:
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Reference 1 State *:
Alabama (AL)
Alaska (AK)
Arizona (AZ)
Arkansas (AR)
California (CA)
Colorado (CO)
Connecticut (CT)
Delaware (DE)
District of Columbia (DC)
Florida (FL)
Georgia (GA)
Hawaii (HI)
Idaho (ID)
Illinois (IL)
Indiana (IN)
Iowa (IA)
Kansas (KS)
Kentucky (KY)
Louisiana (LA)
Maine (ME)
Maryland (MD)
Massachusetts (MA)
Michigan (MI)
Minnesota (MN)
Mississippi (MS)
Missouri (MO)
Montana (MT)
Nebraska (NE)
Nevada (NV)
New Hampshire (NH)
New Jersey (NJ)
New Mexico (NM)
New York (NY)
North Carolina (NC)
North Dakota (ND)
Ohio (OH)
Oklahoma (OK)
Oregon (OR)
Pennsylvania (PA)
Rhode Island (RI)
South Carolina (SC)
South Dakota (SD)
Tennessee (TN)
Texas (TX)
Utah (UT)
Vermont (VT)
Virginia (VA)
Washington (WA)
West Virginia (WV)
Wisconsin (WI)
Wyoming (WY)
Required
Zip Code for Reference 1 *:
Required
Reference 1 Email Address:
Reference 1 Telephone *:
Required
Reference Name 2 (other than a relative) *:
Required
Street Address for Reference 2 *:
Required
City for Reference 2 *:
Required
Reference 2 State *:
Alabama (AL)
Alaska (AK)
Arizona (AZ)
Arkansas (AR)
California (CA)
Colorado (CO)
Connecticut (CT)
Delaware (DE)
District of Columbia (DC)
Florida (FL)
Georgia (GA)
Hawaii (HI)
Idaho (ID)
Illinois (IL)
Indiana (IN)
Iowa (IA)
Kansas (KS)
Kentucky (KY)
Louisiana (LA)
Maine (ME)
Maryland (MD)
Massachusetts (MA)
Michigan (MI)
Minnesota (MN)
Mississippi (MS)
Missouri (MO)
Montana (MT)
Nebraska (NE)
Nevada (NV)
New Hampshire (NH)
New Jersey (NJ)
New Mexico (NM)
New York (NY)
North Carolina (NC)
North Dakota (ND)
Ohio (OH)
Oklahoma (OK)
Oregon (OR)
Pennsylvania (PA)
Rhode Island (RI)
South Carolina (SC)
South Dakota (SD)
Tennessee (TN)
Texas (TX)
Utah (UT)
Vermont (VT)
Virginia (VA)
Washington (WA)
West Virginia (WV)
Wisconsin (WI)
Wyoming (WY)
Required
Zip Code for Reference 2 *:
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Reference 2 Email Address:
Reference 2 Telephone *:
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