Volunteer Form for DIFFA NEW YORK

Thank you for your interest in becoming a valued member of the DIFFA Volunteer Program.

Please fill in the form below and submit for consideration.

Contact Information

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Postal Code *

Phone *

Email Address *

Have you previously done volunteer work for this organization? *

Yes

No

Availabilty

During which hours are you available for volunteer assignments (check all that apply). *

Notes:

Interests

Tell us in which areas you are interested in volunteering *

Special Skills or Experience

Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.

Previous Volunteer Experience

Summarize your previous volunteer experience.

Emergency Contact

Emergency Contact First Name *

Last Name *

Address 1 *

Address 2 *

City, State & Zip *

Emergency Email Address *

Phone Number *

Agreement and Signature

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

Name *

Signature *

Date *

Thank you for completing this application form and for your interest in volunteering with us. It is our policy at DIFFA to provide equal opportunities without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status.