During which hours are you available for volunteer assignments? Type all that apply. * Monday AM; Monday PM
Tuesday AM; Tuesday PM
Wednesday AM; Wednesday PM
Thursday AM; Thursday PM
Friday AM; Friday PM
Saturday AM; Saturday PM
Sunday AM; Sunday PM
Any day; Any time
Tell us in which areas you are willing to serve. Please type all that apply: * South County: Edgewater & all points South
Central County: Annapolis, Riva, Crownsville, Arnold, Severna Park, Millersville
Outside County: Baltimore, Neighboring counties
West County: Odenton, Gambrills, Jessup, Ft. Meade, Crofton, Bowie, Laurel
North County: Brooklyn Park, Curtis Bay, Halethorpe, Glen Burnie, Linthicum, Hanover, Severn, Harmans, Pasadena
Special Skills & Interests
Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports. *
About You
What do we need to know about you in order to make a safe and effective match. (Ex. I am very social, I don't mind multiple trips, I use a cane, I'm allergic to cats...etc.) *
Emergency Contact
Name * Relationship * Street Address * Street Address Apt, Suite, Bldg. (optional) City State / Province / Region Postal / Zip Code Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo (Brazzaville) Congo Costa Rica Cote d\'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (Timor Timur) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia, The Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palestinian Territory Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Western Sahara Western Samoa Yemen Zambia Zimbabwe Country
Home Phone Other Phone *
References (Please provide 2 NOT related to you)
Reference #1 Name * Street Address Street Address Apt, Suite, Bldg. (optional) City State / Province / Region Postal / Zip Code Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo (Brazzaville) Congo Costa Rica Cote d\'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (Timor Timur) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia, The Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palestinian Territory Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Western Sahara Western Samoa Yemen Zambia Zimbabwe Country
Phone * Reference #2 Name * Street Address Street Address Apt, Suite, Bldg. (optional) City State / Province / Region Postal / Zip Code Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo (Brazzaville) Congo Costa Rica Cote d\'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (Timor Timur) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia, The Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palestinian Territory Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Western Sahara Western Samoa Yemen Zambia Zimbabwe Country
Phone *
Volunteer Opportunities Checklist
Transportation Type which areas you are interested in:
I will transport members in my car
Volunteer Aid for Mobility Bus
Help the Program Choose from the following: Receptionist, Transportation Ride Matching, Transporation Intake/Data Entry, Photography, Grant Writing, Entertainment, Database entry, Connect America Admin, General Admin, Fundraising, Translation, Program Advocacy (speaking/health fairs), Marketing/ Social Media, Event Planning
Repairs With Care Type all that apply: Appliances, small repairs, Carpentry, Electrical (small), Masonry repairs, Plumbing (small), Yard work, gardening, FOAS-Bathroom safety equipment installation (training is offered for this task), Boutique donation picks-ups (small items/bags), Technology hook-up & assistance, Gutter cleaning, one story, Painting, Trash removal/ dump runs, Connect America Emergency Response System Installation (training is offered for this task)
Boutique (Anne Arundel County & Frederick) Type which areas you are interested in: Cash Register, Processing, Item Research (E-Bay, etc.), Staging
Member Care Type which areas you are interested in: Household Upkeep (declutter & house cleaning), Baking, Respite, Warm Houses, Errands/Shopping (without member), Phone Buddy, Pet Care, Friendly Visit, Reading/Writing, Peer Advocacy, Learning Socials/Wellness Offerings, Intakes/Interviews
Professional Skills & Tasks Type which areas you are interested in: Taxes, Case Management/ Social Work, Customer Service, CPA/ Accounting, Legal, Notary, Non-Profit, Community Partnerships
Upload Membership Agreement Download the Membership Agreement form at the top of this page. Fill it out, sign, scan or take a photo of it and upload it here. If you don't have scanner capabilities, you can fill out a hard copy at orientation. 
