Name Birth Date Age
Address
City States ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip County
Phone: Work: Cell:
Email: Email 2:
Employer: Occupation:
Please list the name and location of all schools attended and degree(s)/diploma(s) attained.
SchoolDegree(s) and/or Diploma(s) Year
Please indicate the times that you are available to volunteer. Be advised that most volunteer opportunities, other than the Cool Sisters Program, take place during after-school hours Monday through Friday and Saturdays.
Sun Mon Tues Weds Thurs Fri Sat
Have you previously volunteered with Cool Girls? Yes No If yes, when? In what capacity or program?
Do you have experience with children? Yes No If yes, please explain:
Please list any prior or current volunteer experience
Please indicate if you have any special skills or experience in the following: Arts & Crafts Public Relations Cultural Awareness Sports Etiquette Fundraising Counseling Computer Technology Program Development Music/Drama Graphics/Printing Business
Do you have a valid driver’s license? yes no Do you own a motor vehicle? yes no If yes, do you have auto insurance? yes no Has your driver’s license ever been suspended or revoked? yes no Have you ever been convicted of a criminal offense? yes no Do you use illegal drugs? yes no Have you ever been charged with child neglect or abuse? yes no
Other than the above, is there any fact or circumstance involving you or your background that would call into question your being entrusted with the supervision, guidance and care of children/adolescents?
Please list at least (1) personal and (1) professional reference. Name Email Phone
Name Email Phone
Please provide the name and number for at least (2) contacts in case of emergency. Name Email Phone
Name Date