Agency Volunteer Request Form

Please print out this form and mail back to

United Way of Gladwin Co. PO Box 620, Gladwin, MI 48624 or

fax (989) 426-6111

Agency information

Name

Title

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Work Phone

Home Phone

E-mail

URL

Volunteer Title

Objective of Position

Supervisor

Name

Duties and Responsibilities of Volunteer...

Must the Volunteer be 18 yrs. old?

[] Yes
[] No

Minimum age of Volunteer

Age

If students volunteer, what ages would be most helpful?

[] Younger than Jr. High
[] Jr. High School
[] High School
[] College

Qualifications and/or Skills needed for this position...

Training or Orientation required...

Number of hours per week.

Days of the week...

[]Sunday     []Monday     []Tuesday    []Wednesday
[]Thursday   []Friday     []Saturday

Job Location..

Benefits and/or Expenses

Any additional information regarding the volunteer's position.

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
E-mail
URL

Agency Volunteer Request Form

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