It's easy to become a Volunteer for Germaine Lawrence!

Please fill out the following form, and we will contact you as soon as possible. Thanks for your interest!

Program applying for:

If 'other', please explain:
THE FOLLOWING INFORMATION MUST BE FILLED OUT BY ALL APPLICANTS:
Name:
Address:
City:
State and Zip:
Phone (home):
(please include area code)
Phone (work):
(please include area code)
Email address:
Are you over 21 years of age? yes         no
What is your present occupation?
Employer (and address):
What is your work/school schedule?
Education:
Special training or skills you would like to bring to this program:
Are you a licensed driver? yes           no
Do you own or have access to a car? yes           no
Do you have any health restrictions/concerns that would limit your involvement with this program? Please describe:
What is your current community involvement (civic organizations, clubs, etc)?
Please describe any experience you have had with adolescents:
Additional comments, questions, etc:
THE FOLLOWING INFORMATION MUST BE FILLED OUT BY APPLICANTS TO THE AMIGA PROGRAM:
Does your budget allow for the small expense of having a 'little sister'? yes       no
Do you have any pets? yes       no
Is your home accessible by public transportation? yes       no
Who lives in your household?
(give names, relationship, and ages; please use a separate line for each household member)
THE FOLLOWING INFORMATION TO BE FILLED OUT BY ALL APPLICANTS:
Please list 3 references (name, address, phone number) that we may contact:
(please use a separate line for each reference)
How did you hear about our program?
Date of birth:
(optional, for recognition purposes)
By submitting this application, I certify that the information contained within the application is true to the best of my knowledge: yes       no