Volunteer Application

Leu Civic Center, Inc

A United Way Agency

213 N. Market Street, Mascoutah, IL  62258

(618) 566-2175

leuciviccenter.net

Volunteer Application (Please Print)

Name:  ___________________________________ Middle Initial ________

Address: ______________________________________________________

City:  ______________________________  State:  ______ Zip: _________

Phone:  ________________________ Email: ________________________

          Please indicate preferred method of contact:  Email ___   Phone ___

Please indicate skills, strengths, or interests that may be helpful to your volunteer work: (check all that apply)

Teaching/tutoring 

Cooking with kids

Music

Special events

Dance instructor

Arts/crafts

Coaching indicate sport:  ___________________

Other ______________

When you able and willing to volunteer? Please list times you are available under the appropriate days and mark an “X” under the days you are unavailable.

References:

Name: _________________________________ Phone: ______________

E-mail: _____________________________________________________

Name: ________________________________ Phone: _______________

E-mail: _____________________________________________________

The information I provided is complete and accurate to the best of my knowledge.

Signature: _____________________________________Date: ___________