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WYN Volunteer Application

Volunteer Application

Contact Information
Is your physical address different than your mailing address?
This question requires a valid email address.
This question requires a valid date format of MM/DD/YYYY.
calendar
Emergency Contact Information
Some sites are located 8-10 miles outside of town. You must provide your own transportation. Are you willing to do so?
What days are you available? (Check all that apply) *This question is required.
What are your hobbies, skills, special talents, interests, etc?
Please mark any of the following that you are interested in contributing to the program:
  • * This question is required.
Are these volunteer hours required for a specific college course? *This question is required.
List four references (Required for all programs working with youth):
None of which are
related to you or are family friends and must have known you for at least 1 year
References could include: employer, volunteer supervisors, professors, religious leaders
***Please alert all your references that they will be receiving a call from us!
Reference 1
This question requires a valid email address.
Reference 2
This question requires a valid email address.
Reference 3
This question requires a valid email address.
Reference 4
This question requires a valid email address.
This question requires a valid date format of MM/DD/YYYY.
calendar
Family Status: *This question is required.
Do you take illegal drugs? *This question is required.
Background checks are required to work with WYN youth. As you know, WYN is a non-profit organization, and these checks cost $18 for after school volunteers, and $30 for mentors. If you are able/willing to contribute any, or all of the cost for yours, please check the amount below:
*Please discuss with us other payment options if necessary (We don’t want this to discourage you from volunteering at WYN)*
I certify that all information on this application is true.  I understand that any false statements or withheld information on my part will be reason to disqualify me from serving as a volunteer.  I also hereby give my permission for WYN to produce or utilize any media including:  photographs, films, visual recordings, or written accounts of statements for the use of any or all activities authorized by Western Youth Network.  I give my permission to program staff to contact the references I have listed. *This question is required.
Clear
Signature of
Please mark any of the following that you feel may prevent you from fulfilling the required time commitment of 2 hours a week for one year:
  • * This question is required.