Hello, Thank you for your interest in becoming an LRCA volunteer. Before you can become a full-fledged volunteer, we require a completed registration form (see below). Once the Volunteer Coordinator has received your completed registration, we can begin looking for a suitable position where you could play a meaningful role and enjoy yourself at the same time. Feel free to provide any additional information that you consider pertinent. Once we have received your completed registration, expect to hear from us soon.

Please mark an "X" where appropriate and print legibly/type the appropriate information.

Name: _____________________________________________________________

Address: ___________________________________________________________

City ______________________________________________________________

State _____ (ZIP)___________________ Telephone: _______________________

Email: _______________________________

Age: Teen (14+)___ Adult (19+) ___ Senior (65+) ___ Present occupation: Student __ Employed __ Unemployed __ Retired __

Use of automobile (Yes or No): _________ If Yes, Make/Model: ________________________________

Previous Volunteer Experience: __________________________________________________________

Work Experience: _____________________________________________________________________

Awards/Certification: ___________________________________________________________________

I would prefer to volunteer doing: _________________________________________________________

I will commit to: Occasional support ___ 1 day events ___ 3 months __ 6 months __ 1 year __

Special program/event duration desired: ___________________________________________________

I am available: Weekdays __ Weeknights __ Weekends __

My skills/interest/hobbies are: ___________________________________________________________

How much time can you spend volunteering (per week)?_______________________________________

If you are a student, in what field are you studying? ___________________________________________

(volunteering can count as work experience and we can provide you with a letter of reference)

What are you looking for in volunteering? (please "x" appropriate answers)

__ meet people (in person)

__ help people (online)

__ help people (in person)

__ contribute to the development of the LRCA

__ other:__________________________________________________________________

Which of these applies to you:

__ Reliable __ Good Interpersonal skills

__ Friendly __ Good Speaker

__ Good knowledge of LRCA __ Helpful

Please provide us with any other information that you think might be helpful in placing you where your

interests and skills can benefit both you and LRCA.

By volunteering for the LRCA I wish to: __________________________________________________________

I heard about volunteering for the LRCA from: _____________________________________________________

References:

Name: ____________________________________

Relationship: _______________________________

Telephone number: __________________________

Name: ____________________________________

Relationship: ________________________________

Telephone number: ___________________________

Thank you for taking the time to complete this Volunteer Questionnaire. This will help us know more about your interests and what activities you may be most drawn into. Please send this completed form to:

LRCA

Attn: Jack Coyle

P.O. Box 368

Scranton, PA 18501-0368