AGENCY VOLUNTEER REQUEST FORM

IF YOUR AGENCY NEEDS VOLUNTEERS AND IS A NON-PROFIT ORGANIZATION, SCHOOL, LIBRARY, OR MUNICIPALITY'S OFFICE, FILL OUT THE FORM BELOW AND PRESS THE SELECT BUTTON AT THE END OF THE FORM. YOUR AGENCY MUST RESIDE IN OUR LOCAL SERVICE AREA. SHO WILL REVIEW THE REQUEST AND NOTIFY YOU OF YOUR ELIGIBILITY AND THE AVAILABILITY OF VOLUNTEERS. Or you can request a form by calling the office at the number above.

Enter the date Volunteers are needed :

-- mm/dd/yy

Please provide the following agency contact information:

Name and title of agency contact person?

Job title of volunteer?

How many volunteers are needed ?

What will the volunteer's responsibilities be?

Requirements?

Will training be provided? (please describe)

When needed (morning, afternoon, evening, weekends)?

Are volunteers accepted only at specific times of the year?

Is supervision provided?:

YES
NO

Name of supervisor:

What benefits does this placement offer the volunteer? (companionship, training, conferences, workshops, etc.)

Are volunteers reimbursed for any of the following expenses?:

Are volunteers covered by accident insurance?

Does SHO have permission to advertise this request in the media or on the Internet?:

Yes
No