SCL Volunteer Application

Name*

First Last

Email

Phone*

What is the best number to reach you?

Phone - Emergency Contact*

In the event of an emergency, who can we call with information or questions?

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you over 18?*

Due to confidentiality and HIPAA guidelines, the minimum age requirement for most volunteer opportunities is 18.

Are you willing to consent to a background check?*

Please tell us how you heard about Smiles Change Lives*

What made you want to volunteer? Share your story with us!*

Please list current or previous volunteer experiences.*

Are you volunteering to fulfill a court ordered, community service obligation?*

Are you currently employed?*

Where do you work?

Please list the computer software programs you have experience with.*

What do you like to do for fun?*

What is your availability?

We are looking for your general availability for planning purposes.

Signature

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CHANGING LIVES… ONE SMILE AT A TIME…