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. CAPTCHANameThis field is for validation purposes and should be left unchanged.