Student Application

Name*
First Last
Date
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State Zip
Home Phone
Cell Phone*
Email
Languages Spoken
Special Skills
How did you hear about/were you referred to SFVCMHC?
When do you want to start?
MM slash DD slash YYYY
What is the time period you are interested in volunteering?
Do you have any friends/family working for us?*
- Yes
- No
Please tell us who:
Why do you want to be a student volunteer at SFVCMHC?
Student position applying for:
Do you have any previous volunteer experience?
- Yes
- No
Please tell us about it:
Emergency Contacts
Name Phone Relationship
References
Name Phone Relationship

List three people who can serve as a character reference for you. Please give professor or employment references.
Will you need any reasonable accommodations that we should be aware of? If yes, please explain:
Driving
Can you drive if the position requires it?
- Yes
- No
Do you possess a valid California driver's license?
- Yes
- No
License #:
Days & Hours Available
Monday
Morning Afternoon Evening
Tuesday
Morning Afternoon Evening
Wednesday
Morning Afternoon Evening
Thursday
Morning Afternoon Evening
Friday
Morning Afternoon Evening
Saturday
Morning Afternoon Evening
School Experience
School
Years Attended
Degree
Major Studies
Work Experience
Begin with the most recent. List all paid and volunteer experience relative to the position for which you are applying.
Name of Employer
Address of Employer
Street Address City State Zip
Position
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Duties
Professional Licenses, certificates, etc.

87187

Name	Phone	Relationship

Name	Phone	Relationship

Driving

Days & Hours Available

School Experience

Work Experience