Contact Information
    First Name:*
    		 Last Name:*
    Address:*
    		 City:*
    State:*
    		 Zip Code:*
    Phone:*
    		 Email Address:*
    Birthday:*
    		  

    Optional Information
    This section is optional. You do not have to fill it out...
    Pronouns:
    Check one of more options for the set(s) of pronouns you want people to use to refer to you.

    He/him/hisShe/her/hersThey/them/theirsOther
    If Other:

    Volunteer Interests
    (Check one or more opportunities you are interested in)
    For more information about these opportunities, visit the volunteer page
    Interest(s):

    Donation Drives & FundraisersDonate A MealSorting DonationsShelter Activities (arts & crafts, game nights, movie nights, teach a class, etc..Beautification (landscaping, gardening, painting, cleaning and organization)Administrative AssistanceEvent VolunteeringOther
    If Other:

    Availability

    Please list times and number of hours per week you are interested in volunteering.

    Experience

    Please list any previous volunteer experience beginning with the most recent. Include organization name, position, dates (from/to), supervisor name, supervisor phone number.

    Convictions

    Please complete this section if you have ever been convicted of a crime including but not limited to: a misdemeanor and/or felony conviction. (A criminal conviction does not automatically mean that you cannot volunteer at Welcome House).
    Have you ever been convicted of a crime?
    YesNo

    List all misdemeanor and felony convictions with dates. You may include any mitigating factors that you feel should be considered.

    How did you hear about Welcome House?

    Word of mouthInternetSchoolPlace of employmentNewspaperTV/radioChurchBrochureOther
    If Other:

    I certify that the information I have written is true to the best of my knowledge and that Welcome House of Northern KY has my permission to contact the above references.

    I understand that the staff at Welcome House will make final determination regarding the use of my volunteer services in keeping with the best interests of the organization and it's programs.

    Signature:
    		 Date of Application:

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