Collective Souls, Incorporated (CSI) Contact Information Form

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This form is to be completed by individuals providing in-kind support to CSI.

Today's Date:

YYYY

Select your interest of In-kind support: *

Community Advisor Board (CAB)

Mentor

Volunteer

Required

Name *

Birthdate

Complete Mailing Address (e.g. 123 Busy Dr., St. Louis, MO 63123) *

Email *

Contact Number (e.g. 314-000-0123) *

Do you accept text messaging?

Yes

Clear selection

Are you currently employed? If yes, full or part time.

Yes (full-time)

Yes (part-time)

Other:

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If employed, employer's name:

What days are you available?

What times are you available?

Reference name, email and contact number *

Comments (Any information you would like to share with the organization)

Please read before submitting:

I agree to provide assistance, guidance and support to Collective Souls, Incorporated organization and youth programs. I agree to a 1-year commitment in my interest of support or complete the required hours assigned to me. I agree to conduct myself in a professional manner, provide confidentiality regarding youth, services, financials and organization staff; and promote organization services and fundraisers. I am aware that my image/services may be used on organization website and marketing materials. I agree to provide a background check upon organizations request. I agree to notify the organization in writing regarding any changes that may affect my commitment to Collective Souls, Incorporated.

Type your name below showing you have reviewed and agree to the information listed above.

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