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

Asian

Hand 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:

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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.)

PLEASE FILL OUT THIS FORM, PRINT AND MAIL IT TO:

VOLUNTEER APPLICATION
C/O Placer Independent Resource Services
11768 Atwood Rd. #29
Auburn, CA 95603

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Copyright © 2002, 2003, 2004, 2005, 2006, 2007, 2008 Placer Independent Resource Services
Updated: July 23th, 2008