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" indicates required fields
Contact Information
Name
*
First
Middle
Last
Address
*
Street Address
City
Alabama
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Armed Forces Americas
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State
ZIP Code
Date of Birth
*
MM slash DD slash YYYY
Primary Phone
*
Email Address
*
Interest
Referral Source
*
Choose
Volunteer Orientation Ad
Flyer
A Friend or Family Member
My Employer
My School
The ALS Association's Staff
The ALS Association's Newsletter
The ALS Association's Website
VolunteerMatch
Craigslist
Live Well Winona
Another Internet Recruitment Site
Other
Why are you interested in volunteering? Please list any previous experience, reasons for wanting to volunteer and/or what you hope to gain while volunteering.
*
Availability
When are you generally available to volunteer?
Frequency
How frequently would you like to volunteer?
*
One Time
Weekly
Every Other Week
Monthly
Age
What age range are you?
*
17 years & younger
18 years & older
Criminal History
Have you ever been convicted of a criminal offense?
*
No
Yes
If Yes, please explain:
*
Are you in need of community service/court mandated hours?
*
No
Yes
If Yes, please tell us more:
*
Prior Assistance
Have you received assistance from WVS in the past six months?
*
Yes
No
If yes, please explain:
*
Special Accommodations
Do you have health restrictions or require special accommodations?
*
Yes
No
If yes, please explain:
*
Preferences
Assignment Preference
*
Check all that apply.
Clothes Shop
Food Shelf
Home Delivered Meals
Food Rescue
Are there other ways you can help?
*
Emergency Contact
In the event of an emergency, whom should we contact?
Name
*
First
Last
Home Phone Number
*
Work Phone Number
*
Cell Phone Number
*
Email Address
*
Relationship
*
Choose
Aunt
Boyfriend
Brother
Cousin
Co-worker
Daughter
Father
Fiance
Fiancee
Friend
Girlfriend
Grandmother
Husband
Mom
Mother
Neighbor
Parent
Partner
Self
Sister
Son
Spouse
Supervisor
Wife
References
Please provide two professional references we can contact about your application to volunteer. References will not be contacted until after your interview.
1. Name
*
First
Last
Phone Number
*
Alternate Phone Number
Email Address
2. Name
*
First
Last
Phone Number
*
Alternate Phone Number
Email Address
Please explain how you know each of the references you listed
*
I understand that this interest form does not automatically register me as a volunteer. I may need to complete a criminal background check (if 18 years of age or older) in determining my qualifications for volunteering. The information I provided on this application is accurate and current. I authorize WVS to verify this information and contact the references I listed as part of the volunteer screening process.
*
I understand that this interest form does not automatically register me as a volunteer. I may need to complete a criminal background check (if 18 years of age or older) in determining my qualifications for volunteering. The information I provided on this application is accurate and current. I authorize WVS to verify this information and contact the references I listed as part of the volunteer screening process.
I Agree
Step 3
Attending a volunteer orientation is required prior to actively volunteering. Select an orientation date below. All orientations are held in the Chestnut Room at Winona Volunteer Services 402 East Second Street, Winona, MN 55987.
Please select an orientation date below:
*
February 14
March 8
April 12
May 10
June 13
July 11
August 8
September 12
October 10
November 14
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