Online Volunteer Application

Please complete the form as completely as you can.

Please fill out our Volunteer Application Form.
Please note that all volunteers are required to be non-smokers

Volunteer Application

*Salutation:

*Name:

*Street Address:

*City:

*State:

*Zip Code:

*Phone:

E-mail Address:

If You Are Working

Employer:

Occupation:

Does your employer have a formal volunteer program?
Yes No

Does your employer offer volunteer assistance grants to organizations where employees participate as volunteers?
Yes No

If You Are A Student

School:

Birth month/day:

Are you under the age of 18?
Yes No

Education
High School College student College grad Other

How did you hear about volunteer opportunities at the Respiratory Health Association?

Why are you interested in volunteering?

Have you volunteered with RHAMC before?
Yes No

If yes, where, when and what was your assignment?

Please list any previous volunteer experience:

Have you ever been convicted of a felony?
Yes No

If yes, please explain?

I am interested in volunteering for RHAMC in the following area(s):
Environmental Advocacy
COPD Initiative
Flu Program
Advocacy
Office Support
Special Events/Fundraising
Asthma Programs
Tobacco Programs
Special Opportunities
Health Outreach/Health Fairs
Women and Lung Health
Lung Cancer Initiative

Please list skills you have that you would like to share with RHAMC:
Word
Excel
Access
Internet
Typing
Data Entry
Marketing
Fundraising
Public Relations
Finance

Professional Licensures or Degrees
Please specify:

Support Group Facilitator
Other Languages
Please specify:

Other Skills:

Time Availability

The amount of time I would like to volunteer:
Daily, please specify days
Weekly Monthly I am looking for a time-limited project Other
Please Specify: Tee Shirt Size Small Medium Large X-Large

Emergency Contact

All information remains confidential and will only be used in the event of an emergency. In case of an emergency, please contact:

Name:

Phone:

Relationship:

References

Reference 1:

Phone:

What is your relationship to this person?

How many years have you known him/her?

Reference 2:

Phone:

What is your relationship to this person?

How many years have you known him/her?

I certify that the information contained in this application is true and complete to the best of my knowledge and belief. I understand that any misrepresentation or omission of fact in this application will be cause for refusal or termination from the Association. I hereby waive any and all claims against the Respiratory Health Association of Metropolitan Chicago (RHAMC) and its associates arising out of any volunteer event. I understand that the RHAMC may be filming/photographing volunteers during various volunteer activities. I authorize the RHAMC to have an use photographs, slides, legitimate accounts and videotapes of the person named in this application as may be needed for its public relations programs including brochures, nespapers, television, etc.

I agree to these terms:
Yes No

*Required Fields

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Online Volunteer Application