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.
Day | Sunday | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday |
Time |
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: ___________