Changing Worlds

APPLICANT INFORMATION

First Name

M.I.

Last Name

Date

Street Address

Apartment/Unit #

City

State

Zip Code

Phone

Email Address

Availability Date How did you hear about Changing Worlds?

EDUCATION - MOST RECENTLY COMPLETED DEGREE AND/OR LEVEL OF EDUCATION

School

Location

Degree/Certificate

Major/Areas of Study

TYPE OF OPPORTUNITY (Indicate level of interest in each type)

	High	Medium	Low	No interest
Volunteer
Internship
School-based Internship
Board
Committee

AREAS OF INTEREST (Indicate level of interest in each area)

	High	Medium	Low	No interest
Office Support
In-School Program Support (Art/Literacy)
After-School Program Support
Fundraising
Community Outreach Programs
Event Planning
Committees/Boards
Other Areas:

AVAILABILITY - please fill in times from 9 AM - 8 PM

Monday Tuesday Wednesday Thursday Friday

AREAS OF EXPERIENCE OR EXPERTISE (hold COMMAND/ALT button down to select more than one)

Other Area(s) of Experience or Expertise

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge. Anyone who volunteers to work directly with students in-school and after-school settings must undergo a background check before beginning volunteer service. Board and intern inquiries will be required to send in a resume for consideration.

Electronic Signature

Date

WYMSY