Contact InformationName* First Last Mobile Phone*Email* Enter Email Confirm Email Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* MM DD YYYY EducationHighest Level of Education*In High School nowIn College nowAssociate DegreeBachelor's DegreeGraduate or Professional DegreeSchool Name*Enter the name of School attendingCurrent Major*Which school did you graduate from?*Degree obtainedAre you CPR Certified?*YesNoReason for Volunteering*Course/School CreditTo help boost my resume/CVTo ultimately become an Instructor when I qualifyOtherSelect the best choice as it pertains to youPlease Explain why you are applying as a Volunteer*What School are you currently attending?*What is the name of the course you are trying to obtain credit for?Course Director*NamePhoneEmailTitle Fill out the information for the person in charge of your course.Additional informationWhy would you make a great Instructor/Junior Instructor?*Briefly describe any previous volunteer work performed.*Write None if no previous volunteer experienceWhat is your experience working with children?*What is your experience with health sciences?*Employment HistoryDo you have previous work experience?*YesNoPrevious Work Experience*CompanyJob TitleDates workedSupervisorPhone number Require accurate information. You are giving us permission to contact previous employers for reference.AvailabilityDo you have your own reliable transportation?*YesNoPlease explain how you intend to travel to the schoolsAvailable Days to Volunteer* Monday Tuesday Wednesday Thursday Friday Saturday Sunday You are not committing to a schedule at this timeGeneral Available Times to Volunteer* During school hours (9a-3p) After school (3p-5p) Evenings (5p-8p) Weekends You are not committing to a schedule at this time.Child SafetyWill you be able to pass a thorough background check?*YesNoNot surePlease explain*ReferencesProvide at least 2 non-family member references*NameEmail AddressPhone numberRelationship How did you hear about this opportunity?*If you were referred by someone, please list them here.Resume/CV (optional)Background Check Form*The background check form may be downloaded here. Please complete and sign this form before uploading. CAPTCHAEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.