Coach Volunteer Application This application is for adults who have developmental and/or intellectual disabilities, and seek to participate in volunteer opportunities within the non-profit community of the Virginia Peninsula. Date* MM slash DD slash YYYY Volunteer InformationName* First Last Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select the option that best describes where you live.*UrbanRuralSuburbanPrimary Phone*Other PhoneEmail* Please indicate your prefered method of contact*Primary PhoneEmailDo you have an Intellectual or Developmental Disability?* Yes No Please check any Race/Ethnicity that best describes you.* Caucasian African American Native American Hispanic/Latino Asian Pacific Islander Two or more races Other Prefer not to say Please choose the option that best describes you.*MaleFemaleOtherPrefer not to sayDo you have a valid VA Drivers License?* Yes No Do you have your own transportation to volunteer sites?* Yes No Educational BackgroundCheck all that apply.* Applied Studies High School Diploma Modified Standard HS Diploma Standard High School Diploma GED Vocational/Trade School College Highest Grade Completed Certifcation/Licensure Do you have First Aid Training?* Yes No Expire Date for First Aid Training Are you CPR Certified?* Yes No Expire Date for CPR Certification. Do you have Military Experience?* Yes No Active Duty Military? Yes No Retired Military? Yes No College Attendance (If Applicable)College 1: City/State Dates of Attendance Degree/Major College 2: City/State Dates of Attendance Degree/Major Volunteer DetailsPlease indicate an area you are interested in volunteering, i.e. working with animals, ethics work, working with people.*Select the days you are available to volunteer.* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Provide specific times you are available on the days indicated above.*Let us know if you need help with.... Mobility Reading Standing for long periods Other Please share about the 'other' you selected above.Have you ever been convicted of a felony?* Yes No Provide detail of your felony conviction. Date, City/State of conviction and reason for conviction.Work and Volunteer ExperienceStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Job/Role Title Describe Job or Volunteer DutiesStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Job/Role Title Describe Job or Volunteer DutiesStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Job/Role Title Describe Job or Volunteer DutiesStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Job/Role Title Describe Job or Volunteer DutiesStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Job/Role Title Describe Job or Volunteer DutiesReferencesFirst Reference* First Name Last Name Phone*Email* Second Reference* First Name Last Name Phone*Email* By Applying I agree to and understand the following:As a volunteer of Community Knights, I agree to abide by the policies and procedures of all non-profit sites. I understand that I will be volunteering at my own risk and that the organization, its employees, and affiliates, cannot assume any responsibility for any liability for any accident, injury or health problem which may arise from any volunteer work I perform for their organization. I agree that all work I do is on a volunteer basis and I am not eligible to receive any monetary payment or reward.By selecting Yes, you agree to the above.* YES
