Applicant Information
Name:
Street Address:
City, State, Zip:
Home Phone:
Work/Cell Phone:
E-Mail Address:
Best Way to Contact You:
Occupation (Optional):
Employer (Optional):
Part Time of Full Time:
Spouse:
Spouse Occupation (Optional):
Spouse Employer (Optional):
Children:
Do you wish to include your children when volunteering?
Birthday:
Emergency Contact:
Availability

During Which hours are you available for volunteer assignments? Please rank your availability preference from 1-3, 1 being the best and 3 being the worst.
Mon. - Fri. 9a-12p 1   2   3   Mon. - Fri. 1-3p 1   2   3   Mon. - Fri. 3-6p 1   2   3   Mon. - Fri. 6-9p 1   2   3   Mon. - Fri. Other 1   2   3	Saturday: 8a-12p 1   2   3   Saturday: 1-5p 1   2   3   Sunday: 8a-12p 1   2   3   Sunday: 1-5p 1   2   3   Weekend: Other 1   2   3

Interests
Tell us in which areas you are interested in contributing. This will help us assign you to a Committee. Please rank in order of your preference 1-5.
Communications	1     2     3     4     5
Membership	1     2     3     4     5
Leadership	1     2     3     4     5
Events	1     2     3     4     5
Projects	1     2     3     4     5
Treasurer	1     2     3     4     5
Fundraising	1     2     3     4     5
Historian	1     2     3     4     5
Special Skills or Qualifications
Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.
Skills/Qualifications:
Previous Volunteer Experience
Summarize your previous volunteer experience.
Volunteer Exp:

Where and how do you like to volunteer your time? (Rank in order of preference from 1-8.)
Animals (Examples: Collecting and donating food to local animal shelter, helping shelter find homes for homeless animals, foster parenting domestic animals, join a canine program that visits hospital patients)
1     2     3     4     5     6     7     8
Children (Examples: Tutoring children, reading and playing with special needs children, mentoring.)
1     2     3     4     5     6     7     8
Elderly (Examples: Provide transportation to and from doctor’s appointments, cleaning houses, companion programs, visiting retirement homes)
1     2     3     4     5     6     7     8
Environment (Examples: Adopt a park, street, building or neighborhood to clean and tend plants – a good project to include children)
1     2     3     4     5     6     7     8
Expectant and New Mothers / Babies (Examples: counseling and training for expectant or new mothers, gathering and donating clothing and baby furniture)
1     2     3     4     5     6     7     8
Hospice (Examples: Provide “end of life” friendships, help transport cancer patients to and from doctor appointments)
1     2     3     4     5     6     7     8
Homeless ( Examples: Tutor and play with children in shelter, provide clothing, provide daycare services while parent searches for a job, donate furniture when they find a home, offer transportation services, help people to find jobs, offer adult literacy programs)
1     2     3     4     5     6     7     8
Women (Examples: Job training, affordable daycare, provide work clothes, mentor, offer experience such as help those grieving the loss of a child/family member, aid in job searches)
1     2     3     4     5     6     7     8

* Please read the Membership Expectation before signing this Agreement
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a member, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
Electronic Signature. (Type your full name.)
Date:

Our Policy

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Thank you for completing this application form and for your interest in joining Suffolk 60 Care.

Suffolk 60 Care Mission Statement

Suffolk 60 Care is an organization of motivated individuals committed to providing quality volunteerism by acting as a catalyst for community change while developing individual potential through leadership.

Suffolk 60 Care Membership Benefits

• Training for effective community service and leadership, including finance, fundraising, leadership, public relations and marketing, advocacy and personal development
• Gaining an awareness of community needs and opportunities to contribute to solutions
• Interacting and partnering with community leaders
• Building new friendships and opportunities for continued growth and personal fulfillment
• Exposure to creative strategies in problem solving and administration of a non-profit organization

Suffolk 60 Care Membership Expectations

Active members are those members who meet the following criteria:
1. Complete Active Member requirements during the S60C fiscal year.
2. Attend 80% of all regularly scheduled meetings.
3. Actively participate and serve on a committee and attend 75% of such committee meetings.
4. Support S60C’s Signature Project by completing 9 volunteer opportunities per year.
5. Attend one training session per year.
6. Attend one “One Day Wonder” per year.
7. Attend one S60C Event per year.
8. Support S60C through annual membership dues of $150.