Name *

First Name

Last Name

Phone *

(###)

###

####

Birthday *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergecy Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

What services are you interested in? *

Meals on Wheels

Building Services

Housing

NAM Resale

Pediatric Health Center

Young at Heart Senior Center

Learning & Vocational Training Center

Development

Joanne Watford Nutrition Center (Food Pantry)

Family Violence Center (Special Conditions and Training)

Client Intake

Clerical Work

Day of the week you prefer to volunteer? *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Time of day you prefer to volunteer? *

Morning (9 AM - 12 PM)

Afternoon (1 PM - 5 PM)

All Day

Start Date *

2 Weeks

30 Days

Other (Special Project)

Are you a member of any religious congregation(s) and/or service organization(s)? *

Yes

No

CERTIFICATION AGREEMENT *

NAM clients are welcome to volunteer 12 months after last assistance was received in any of NAM's programs and services. Former NAM staff who have left NAM's employment in good standing will be accepted for volunteer work at NAM after 12 months have elapsed since leaving the organization. I certify that all the information provided above is true and correct to the best of my knowledge. Should any of this information change during my service with NAM, I will submit updated information to the organization at my earliest opportunity.

I agree to the NAM Volunteer terms of service.