Tioga County Homeless Initiative Volunteer Application

Name:                                                                                                                                                   DOB:                                    

                                First                       Middle Initial                      Last

Address:                                                                                                                                                                                             

                      Number and Street                                   City                                        State                     Zip Code

Home Phone #:                                                                  Cell Phone #:                                                     Email:                                 

Are you currently on probation? Y or N                                  Probation Officer:                                                                           

Reason for probation:                                                                                                                                                                                                                                                                                                                                                                                   

Number of Hours Needed:                                             Time Available:                                                                             

Volunteer Interests:

□ Cleaning                           □ Organizing                       □ Filing                  □ General Maintenance                                               

□ Computer Work           □ Yard Work                       □ Inventory        □ Other:                                                              

Allergies:                                                                                                                                                                                            

Other information needed:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        

Signature:                                                                                                                                                                                          

Date: