The Arc of Tucson Volunteer Program
        
Name: ___________________________________ Member of _______________ Local Arc Unit _____________________

Address: _________________________________ City: ___________________ Zip: _________

Phone: (Home) ______________________(Work) _________________________ (Emergency) _______________________ 

Previous Work Experiences/References (last three places of employment):

Reference Name/Title: ____________________________________ Phone: ________________

Address: ______________________________________ City: ______________ Zip: _________

Reference Name/Title: ____________________________________ Phone: ________________

Address: ______________________________________ City: ______________ Zip: _________

Language (s) fluent in: ______________________________ Have you ever been convicted of a felony: ____Yes ____No

Experiences, Special Interests, Organizations, Affiliations: _______________________________________________________
________________________________________________________________________________________________________

Area(s) of Interest: (please check) [  ] clerical [  ] public relations [  ] educational advocacy [  ] special activities 
[  ] advising self-advocates [  ] guardianship [  ] residential monitoring visiting

Any preferences or exceptions regarding LOCATIONS or DISABILITIES: _____________________________________________
_________________________________________________________________________________________________________
Have you volunteered before: __ Yes__ No  If "Yes", where, when, # of hours/month, and for how long did you volunteer: _________________________________________________________________________________________________________

Why do you want to volunteer at this time: ______________________________________________________________________

How much time (hours) per month are you willing to commit: _______________________________________________________

What DAYS of the week and TIMES are you available: ____________________________________________________________
________________________________________________________________________________________

Applicant Signature: _________________________________________ Date: _______________

Please print out form and mail or fax to: The Arc of Tucson, P.O. Box 44324 Tucson, AZ. 85733  Fax: (520) 760-1570