Volunteer interest form Name * Required First Last Address * Required Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email * Required Cell Phone NumberExperienceHow did you learn about Noorthoek Academy?Have you volunteered before? Where?Describe previous experience working with individuals with disabilities.Why do you want to volunteer at Noorthoek?Are you volunteering as part of a school requirement?If you are a student please provide where you attend, field of interest, and how many years you have been studying.Current Employer? Title and how many years have you been employed?Please check all volunteer opportunities that you are interested in: Classroom mentor Social mentor Individual mentor Events Class speaker What days do you wish to volunteer?What times are you available?ALL APPLICANTS MUST ANSWER THE FOLLOWING QUESTION. FAILURE TO ANSWER HONESTLY WILL DISQUALIFY THE APPLICANT FROM SERVICE AS A VOLUNTEER WITH OUR ORGANIZATION. I represent that all information provided in this application is true to the best of my knowledge. I understand that my volunteer status may be terminated at any time by either party with or without cause. I further agree to comply with the policies and procedures, as well as safety practices of Noorthoek Academy. I give permission for me to be photographed or videotaped in Noorthoek activities and allow us to use these photos in the newsletter, slideshow, and/or general promotional usage. Any photo utilized will be done so in a most respectful manner, and in no way, shall be used to exploit me. I further state that I have signed this agreement voluntarily after fully informing myself of its contents. I authorize Noorthoek Academy to check and verify all information on this application. To serve the best interest of Noorthoek clients/students, Noorthoek will conduct a criminal background check on all volunteers. I fully release references, employers and Noorthoek from any liability resulting from the verification process. * Required Yes No Have you ever been convicted of a felony or are there any felony charges pending against you? If so please explain.Emergency contact nameRelationshipPhone