Individual Application Volunteer Sign Up Sign up for individual opportunities Thank you for your interest in volunteering with Status: Home! A staff member of our Volunteer Services will contact you within 72 hours to begin the process of becoming an individual volunteer. Individual Volunteer ApplicationFull Name(Required) Street Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Home PhoneWork PhoneMay we call you at work? Yes No Are you 18 years or older? Yes No Are you retired? Yes No Gender? Male Female Email Address Birthdate MM slash DD slash YYYY Current Employer Employer Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Education Completed High School College Graduate School Special Skills, Training, or HobbiesLanguages Spanish French Sign for Hearing Impaired Other Are you seeking court ordered community service hours? Yes No How did you hear about our volunteer program and why are you interested in becoming a Status: Home volunteer? Please check the volunteer role (s) You are most interested in below: Tutor:Provides educational support and encouragement to residents of all ages. Recreation/Playground Coordinator:Engage youth in positive social interaction through games and fun activities. Clothes Closet Coordinator:Sorts and organizes donated clothing and household goods. Gardening/Landscaping:Assists with weeding, raking, planting, mowing, and maintaining residential grounds. Maintenance:Assists with minor carpentry, painting, and small home repairs for residential facilities. Resource Assistant:Works closely with one to two residents to help identify and achieve service plan goals. Social Activities Coordinator:Plan/host social activities for residents on or off site such as bowling, concerts, etc. Special Event Representative/Participant:Represents Status: Home as a volunteer at a variety of off-site events. Speaker’s Bureau Member:Represents Status:Home as a speaker/advocate for agency initiatives. Please check the day(s) And time(s) You would be available to volunteer.Monday Morning Afternoon Evening Tuesday Morning Afternoon Evening Wednesday Morning Afternoon Evening Thursday Morning Afternoon Evening Friday Morning Afternoon Evening Saturday Morning Afternoon Evening Sunday Morning Afternoon Evening Personal ReferencesReference #1 - Name Reference #1 - Email Reference #1 - Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Reference #2 - Name Reference #2 - Email Reference #2 - Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Emergency ContactFull Name PhoneConsent(Required)I hereby certify that all information in this application is true and correct to the best of my knowledge. I understand that any falsification or significant omission of any information requested herein will be sufficient cause for discharge without prior warning at any time during my volunteer service at Status: Home. Further, I release Status: Home from any liability based upon information given to them by references named above. If accepted as a Status: Home volunteer, I am willing to follow rules and regulations established by the Board of Directors, including signing confidentiality and sexual policy agreements. I agree(Required)