Volunteer Application

Name *

First

Last

Email *

Phone

What kind of work are you interested in?

• Medical/Dental Clinic
• Social Service Assistant/Community Service Assistant
• Teacher Assistant at Mari’s Place
• Yard work/Cleaning/Maintenance

Is this for a university internship?

• Yes
• No

Why do you want to volunteer at COI?

What skills do you have that will help COI’s clients?

Please list one or two references who are not relatives (name, how you know them, contact info)

Is there anything else we should know?

Are you volunteering in order to fulfill court-ordered community service?

• No
• Yes

Website

Submit

Would you make a monthly gift to support COI?

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