Volunteer Application Volunteer Application Name* First Last Date* MM slash DD slash YYYY Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone*Other PhoneEmail* Social Security Number*Have you ever volunteered with FCC before?* Yes No Have you ever been convicted of a felony?* Yes No Have you had any criminal convictions for child abuse or sex-related crimes?* Yes No Why are you interested in volunteering with FCC?*Are you required to volunteer?* Yes No If yes, how many hours are needed?What is the deadline to complete the hoursName of school/agency/ government body requiring community service:Please indicate the days and times you are available to volunteer:*MondayTuesdayWednesdayThursdayFriday ReferencesList three references that have known you for at least three years whom you authorize us to contact. References may include supervisors, co-workers, faith leaders, teachers or school counselors. Family Member Name First Last Email PhoneYears KnownPersonal or Professional Name First Last PhoneEmail Years KnownPersonal or Professional Name First Last PhoneEmail Years KnownSignature of Applicant*Date* MM slash DD slash YYYY Parent Signature (If applicant is under 18Date MM slash DD slash YYYY Δ
