Youth Volunteer Application (for volunteers age 14 to 18)

Today’s Date: 11/21/2008	* Denotes Required Fields
Contact Information:
Name (First, MI, Last):*
Home Address:*
City:*		State:*		Zip:*
Home Phone:*		Email:*
Date of Birth:*
Background Information:
Name of School:*
Address of School:*
City:*		State:*		Zip:*
Grade:*
Volunteer Information:
How did you hear about OMNI (i.e. newspaper; please be specific)?:*

Are you committed to other volunteer service organizations (clubs, church, community, school)?:*

What are your hobbies and interests? List four major areas:*
1:
2:
3:
4:
When can you begin participating?*

Can you meet two to three times a month?*
YesNo
If no, when are you available?

What foreign language (s) do you speak, read or write?

Have you ever been convicted of a crime?*
YesNo
If yes, please explain:

I certify that all of the information given to OMNI Youth Services is true and correct.*
Signature:		Date:	11/21/2008
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