Volunteer Application


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.


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: ___________