PIRS

Volunteer
Application

Name:

Email Address:

Address:     [apt. #]:

City:     State:     Zip Code:

Phone Number: ()-

SSN#:

Driver's Lic#:

Emergency contact:     Relationship:

Address:     Phone Number: ()-

Accommodations Needed:

Languages:
Spanish French AsianHand Signing

Other Languages:

Volunteer/Background:

Referral {How did you find us?}

Days available (Please check all that apply)M T W Th F

A.M.
[10-1]
P.M.
[1-4]
Other
(Please Specify)

Comments:


PIRS
VOLUNTEER INTEREST LIST

Typing     wpm

Computer: MSWord     MSAccess (Data entry)

Filing
 
Receptionist/Phone
 
Mailings
 
Preparing Newsletter
 
Library/Research
 
Transcribing
(cassettes, braille)
 
Reading/Writing
(correspondence, bills, etc. for visually impaired)
 
Systems Advocacy
(phoning, letter writing, arrange for speakers, etc.)
 
Field Surveys on Accessible Housing
(training and mileage reimbursement provided)
 
Public Relations
 
Peer Support (Must have a disability)
 
Fund Raising
 
Gardening
 
Photography
 
Accounting/Auditing
 
Carpentry/Handyman
 
Interpreting
(sign, finger spelling, Spanish, etc.)