Home Address (House Number, Street, Borough, State, Zipcode) *
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Race/Ethnicity *
Preferred contact method *
必填
Please list your name/s on social media for Facebook, Instragram and/or Linkedin below. *
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What is your current profession? *
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Please list any professional licenses or certifications you hold *
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Highest level of Education *
Are you a new or existing volunteer or intern? *
必填
How are you interested in helping? *
必填
Why are you interested in volunteering? *
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Have you been personally impacted by COVID-19? If yes please explain how *
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Please provide 2 character references that we may contact. Include first and last name, phone number/s, email address and best time to contact reference. *
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If you are below 18 years of age, Kindly provide your Parent contact information. Include first name, last name, email address, phone number and best time to contact.
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Are there any specific interests you have? For example working with a certain age or population. If none please indicate, None. *
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Do you speak any languages other than English? If yes kindly list below.
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Are you a US citizen? *
If you are not a US Citizen, are you legally authorized to work in the US?
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Have you been fingerprinted previously by the your city or state Department of Health or Department of Education or any other city, state or federal entity? If yes, please specify. *
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Do you have access to an electronic device AND internet to volunteer virtually? If you answered no to either, please explain below. *
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What is your availability to volunteer? (please indicate days and times) *
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How long are you available to volunteer? *
How soon are you available to start? *
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I have answered all questions accurately and honestly and to the best of my ability and knowledge. I understand that completing this form does not guarantee my acceptance as a volunteer. My acceptance is contingent on space and availability. By initialing below, I agree with this statement. (Please initial below) *
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