Name
*
First Name
Last Name
Email
*
Mailing Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone Number
*
(###)
###
####
Emergency Contact
*
First Name
Last Name
Emergency Contact Relationship to Applicant
*
Emergency Contact Phone Number
*
(###)
###
####
Professional Reference Name
*
First Name
Last Name
Professional Reference Phone Number
*
(###)
###
####
Professional Reference Email
*
I am over 18 years old or at least a junior in high school.
*
Foreign Languages Spoken
Occupation (present or former)
*
Areas of Interest or Expertise (check all that apply)
*
Please list any other areas of interest or expertise you might have.
College Experience
Work/Volunteer Experience
*
Which Volunteer Opportunities interest you (check all that apply)?
*
If you have any special talents you would like to share, such as flint knapping, wood carving, basket weaving, signing, etc, please let us know:
What time you like to volunteer?:
*
Would you like to volunteer:
*
(8 volunteer hours per month minimum commitment required)
What day(s) of the week would you like to volunteer?
*
PLEASE READ CAREFULLY
*
Volunteers are the face and the voice of the Western Science Center. The Western Science Center maintains the final decision in determining the eligibility of prospective Volunteers through satisfactory completion of all course requirements. Continual evaluations will be conducted to maintain high standards of performance. If a Volunteer (in training or practice) does not follow the policies and philosophy of the Western Science Center, he/she will be asked to resign. Volunteers should understand the Western Science Center’s educational goals and maintain a professional attitude and appearance at all times. Failure to adhere to the responsibilities as outlined in the Volunteer Manual and above concerning training, attendance, assignments, and evaluation, may affect final acceptance and continuation in the Volunteer Program.
I, _________________________, understand that the Volunteer Program is a one-year commitment, in addition to training session(s), and that acceptance into the Western Center’s Volunteer Program is on a provisional basis until it is determined that I have successfully completed training. I agree to a criminal background check with fingerprinting. If I possess a current Department of Justice clearance, I will supply proof.
By checking yes, you are agreeing to a criminal background check with fingerprinting.
*
Checking yes below indicates that I am the person stated above and that all of the information is true and correct to the best of my knowledge. Forgery or false information will result in dismissal from the volunteer program.
*
