Volunteer Application | Two Rivers Head Start Agency

General Information

Welcome – we are excited you are interested in volunteering with Two Rivers Head Start Agency! There are many opportunities for volunteers to participate and help with our mission: to alleviate the effects of poverty by providing education, support services and opportunities for children, families and communities.

For a copy of the application that can be downloaded and emailed or faxed to our staff click here.

Name:*

First Middle Last

Primary Phone:*

Secondary Phone:*

Email:

Address:*

Street Address City State / Province / Region ZIP / Postal Code

Date of Birth

Are you currently employed?

Yes
No

Current Employer

Are or were you a Head Start Parent:

Yes
No

How did you find us:

Agency Website
Referral

Referral by who?

Are you related to anyone currently employed or serving on Policy Council/Board:

Yes
No

If yes, who?

Volunteer Position:

Center Location:

Education

Highest Level of High School Completed:*

Freshman Year
Sophomore Year
Junior Year
Senior Year

Highest Level of College Completed:*

Are you able to provide proof of educational attainment such as transcripts, diploma, or certificates?*

Yes
No

If applying for Classroom Volunteer, do you have any ECE credits or experience?

Yes
No

Degree/Major:

Trade, business, certifications or other specialized training/skills:

Computer applications/programs or office machines with which you are familiar:

Indicate any foreign language(s) in which you are able to communicate and your proficiency:

Miscellaneous

***Please note that a background check will be required for most volunteer positions. Please advise if this is not acceptable.

Please list any prior volunteer experience:

Comments or additional information you would like to share:

Briefly describe why you want to volunteer for Two Rivers Head Start Agency:

References

Please list three professional references below:

Reference #1:

Phone Number:*

Address:

City:

State:

Relationship:

Reference #2:

Phone Number:*

Address:

City:

State:

Relationship:

Reference #3:

Phone Number:*

Address:

City:

State:

Relationship:

Availability: Please indicate the days and times you are usually available to volunteer.

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

If you are volunteering for a school requirement or internship, please complete the following:

School Name:

Contact Person:

Phone Number:

Number of Required Hours:

Emergency Contact:

Contact name:

Relationship:

Primary Phone:

Secondary Phone:

Contact name:

Relationship:

Primary Phone:

Secondary Phone:

Volunteer Guidelines:

Please arrive on time. If you are not able to make your volunteer shift or will be late, please call ahead to let the center know.
Casual attire is appropriate for most volunteer positions. Closed toe shoes are required. Jewelry should be worn with discretion and attention to safety.

Disclaimer and signature

I certify that the answers given herein are true and complete to the best of my knowledge. I understand that in the course of my volunteer assignment, I may be exposed to information of a confidential nature pertaining to children, families, and employees and will maintain the highest standards of confidentiality and uphold the Agency polices to safeguard the rights of those we serve.

I understand and fully acknowledge that in volunteering for Two Rivers Head Start Agency, I am entering an at will relationship and that this relationship can be terminated at any time by me or by Two Rivers Head Start Agency. I also understand that I am applying for a volunteer/intern position and that this is not an application, nor a contract of paid employment.

I understand and agree that submitting this application form does not automatically register me as a Two Rivers Head Start Agency volunteer, and that there may be certain requirements I must meet, including a physical health screening, TB test, and background check clearance.

Consent:*

I agree to the above statements and information listed.

Volunteer Applicant Signature:*

First Last

Date:*

Email

This field is for validation purposes and should be left unchanged.