Name(required)

Title

Organization/School

Your Email (required)

Phone

Mailing Address(required)

City, State, Zip(required)

What kind of information do you need?

What are your volunteer interests?
 Office help Website Other marketing Special event assistance Film/videography Research Presentations Committees Speakers Bureau Voices of Recovery Other

If "Other":

What groups are interested in reaching out to?
 General Public Seniors Youth Asian community Native American Hispanic/Latino Other

If "Other":

Are you currently enrolled in school?
 No Yes

If yes, which school:

Computer skills:
 Word Excel Outlook Quickbooks FileMaker Other

If "Other":

Foreign language skills:

Other skills, training, or talents:

When and how often do you want to volunteer?:

Which days are you available?:
 Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Are you available on short notice?:
 Yes No

Current employer:

How many hours per week do you work?:

Other current volunteer work:

Please list your work and volunteer experience:

By checking the box below, I give permission to the Evergreen Council on Problem Gambling to obtain information regarding my previous volunteer and/or work experience. I certify that the facts in this volunteer application are true to the best of my knowledge. I hereby release the Evergreen Council on Problem Gambling and its staff from any and all liability for loss, damage, injury, or illness to any person or property which may be incurred through participation in the ECPG volunteer program. I understand that I have the option of refusing to perform any work task that I feel may be unsafe or have the potential for personal harm, and that it is my responsibility to make such a determination.

I agree(required)
 Yes

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