CISSC Volunteer Application

Your Information

First Name *

Last Name *

Email *

Date of Birth *

Address Line 1 *

Address Line 2

Phone *

City *

State *

Zip *

Emergency Contact

Emergency Contact Phone

Emergency Contact Email

Race

Employer or College

Employer Name The maximum length for the field Employer Name is 500 characters.

College/University Name The maximum length for the field College/University Name is 500 characters.

If you are a student, is this for an internship? The maximum length for the field If you are a student, is this for an internship? is 500 characters.

Volunteer Information

What volunteer role are you interested in? (select all that may apply) * The field What volunteer role are you interested in? (select all that may apply) is required.

School District Interested in Volunteering at * The field School District Interested in Volunteering at is required.

Do you have an age preference?

Specify if you prefer a particular school. If unknown, complete box with "unsure" or "n/a". * The field Specify if you prefer a particular school. If unknown, complete box with "unsure" or "n/a". is required.

List the days you are available: Monday-Friday * The field List the days you are available: Monday-Friday is required.

Time Preference * The field Time Preference is required.

Please list any previous relevant experience: The maximum length for the field Please list any previous relevant experience: is 500 characters.

How did you learn about this volunteer experience? The maximum length for the field How did you learn about this volunteer experience? is 500 characters.

Please note why you want to volunteer with CISSC * The field Please note why you want to volunteer with CISSC is required.

Do you speak any language(s) other than English? The maximum length for the field Do you speak any language(s) other than English? is 500 characters.

Please list any hobbies, talents or skills? The maximum length for the field Please list any hobbies, talents or skills? is 500 characters.

Preferred start date (month/year) The maximum length for the field Preferred start date (month/year) is 500 characters.

References

List two references, preferably who have known you for at least three years. References may be from your employer, friends, teachers, fellow employees, past volunteer supervisors or clergy. Relatives may not be used as references.

Reference #1

Name * The field Name is required.

Phone Number * The phone field Phone Number is required.

Relationship The maximum length for the field Relationship is 500 characters.

Years Known * The numeric field Years Known is required.

Reference #2

Name * The field Name is required.

Phone Number * The phone field Phone Number is required.

Relationship The maximum length for the field Relationship is 500 characters.

Years Known * The numeric field Years Known is required.

A criminal background check is required to be a Communities In Schools of South Carolina volunteer. Please follow the steps on the previous page to complete the backgroud check process with the appropriate school district.

Are you willing to submit a background check? * The field Are you willing to submit a background check? is required.

The information given is true to the best of my knowledge. I grant permission to contact the references provided. I acknowledge that CIS can refuse my services as a volunteer without explanation.

I agree with the above statement. * The field I agree with the above statement. is required.

Signature * The field Signature is required.