Gratitude in Action Volunteer Application

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Email *

First Name *

Last Name *

Mailing Address *

Phone Number *

Email Address *

How did you learn about Gratitude in Action? *

Are you representing a group, school, or organization? *

Yes

If yes, what is the name of your group, school, or organization? *

Briefly explain why you want to volunteer with Gratitude in Action. *

Have you ever been charged with a felony? *

Yes

Have you ever been convicted of a felony? *

Yes

Do you have to register as either a violent or sexual offender? *

Yes

Do you have to abide by any sex offender restrictions? *

Yes

Please select your household income level. *

$0 to $16,450

$16,451 to $43,900

$18,801 to $50,150

$21,151 to $56,400

$23,501 to $62,650

$25,401 to $67,700

$27,301 to $72,700

$29,151 to $77,700

$31,051 to $82,700

Prefer Not to Answer

Other:

Required

Are you Hispanic or Latino? *

Yes

Prefer Not to Answer

Please select one of the following that best describes you: *

White

Black or African American

Asian

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

American Indian or Alaska Native and White

Asian and White

Black or African American and White

American Indian or Alaska Native and Black or African American

Other Multi-Racial

Prefer Not to Answer

Household Type - Please check all that apply: *

Elderly (over 62)

Disabled

Female Head of Household (with dependents living in your home)

Currently Experiencing Homelessness

Prefer Not to Answer

Required

Liability Disclaimer: By submitting this application, I confirm that all of the above information is correct. As a volunteer of Gratitude in Action, I agree to abide by the policies and procedures. I understand that I will be volunteering at my own risk and that the organization, its employees, and affiliates cannot assume any responsibility for any liability for any accident, injury, or health problem which may arise from any volunteer work I perform for the organization. I understand that all of the work I do is on a volunteer basis and I am not eligible to receive monetary payment or reward of any kind for my services performed. Please type your full name and date. *

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