Hillsdale County United Way & Volunteers In Action
30 N. Howell St., Ste. 21, P.O. Box 203
Hillsdale, MI 49242
Phone: (517) 439-5050
Fax: (517) 439-5058
AGENCY REQUEST FOR VOLUNTEERS
Date of request: _________________________
Organization Name: ____________________________________________________________
Address: ____________________________________________________________________
Contact Person: _________________________ Phone: ______________________________
Fax: __________________________________ E-Mail: ______________________________
Number of Volunteers Needed: ___________________ Min. Age: _______________________
Volunteer opportunities available for persons with mental/physical disabilities,
except as described below:
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VOLUNTEER INFORMATION
Title: ________________________ Skill Requirement: _______________________________
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Job Description/or see attached sheet: ______________________________________________
Equipment: ___________________________________________________________________
Training Provided: Yes _____________ No________________________________________
Volunteer Reports To: __________________________________________________________
Work Site Address: _____________________________________________________________
TIME COMMITMENT
Date(s) Needed: _____________________________ Or Ongoing: ______________________
Mon. ____ Tues. ____ Wed. ____ Thurs. ____ Fri. ____ Sat. ____ Sun. ____
Time(s) Needed or Shift: ________________________________________________________
Number of Volunteers Needed Per Shift: ____________________________________________
Notes: _______________________________________________________________________
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Agency Representative: _________________________________________________________