Teen Volunteer Application

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Teen Volunteer Application for Senior Access. If you have questions or concerns, please contact Melinda Ross at 512.310.1060 or email at volunteer@senioraccesstx.org

Email *

First Name *

Last Name *

Date of Birth *

YYYY

Address *

City *

Zip Code *

Gender *

Female

Male

Other:

Ethnicity

Phone Number *

What is the best way to reach you?

Parent/guardian phone or email address

Your cell phone

Your email address

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Emergency Contact Name *

Emergency Contact Phone Number and Email Address *

Emergency Contact Relation (parent, grandparent, etc) *

Please list two people for a reference with phone numbers. *

Have you ever been arrested/convicted? (A conviction may not disqualify you; however, failure to fully disclose all information will.) For minor traffic violations, simply write "traffic." *

Languages other than English you speak or write.

General interests, hobbies, skills *

How did you hear about Senior Access? *

Why do you want to volunteer with Senior Access? *

How would you like to volunteer with us?

Volunteer with parent to ride along on drives, help with yard work or minor home repairs * Parents must sign up to volunteer. Go to senioracesstx.org/volunteer to find the application.*

Van Volunteer. Vans run Monday through Thursday between 8:45 am to about 2:00pm and on some Fridays and we are closed during Thanksgiving and Christmas break. Volunteer during the summer or days you are out of school.

How long do you plan to volunteer with us? *

At least 2 months

At least 1 semester during school

During the summer months

Other:

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