Intake Form

Student ID
Last Name
First Name
Phone Number
Email Address
Street Address
City
State
Zip Code
Areas of Interest (select all that apply)
Give tours at a museum or zoo

Teach children or adults how to read

Assist in sorting/distributing of food or clothing

Assist as mentors or tutors for children
Work at local hospitals

Work at a shelter

Entertain senior citizens at a nursing home

Provide assistance in support groups (domestic/ drug abuse)

Recreational activities (arts/ crafts/ sports)

After school programs

Beautify local neighborhood or the environment

Assist people with different illnesses

Administrative volunteer (clerical work)

Working among diverse cultures

Community health and education fairs

Assist in local school
Group leader in children camps

Restoring homes
Work with animals
Other: