Full Name: 

Address:   

Phone (Home):

Phone (Work):

Phone (Other):

Email Address:

Are you volunteering with Best Buddies? (CU Students only)  Yes   No
If yes, stop here, do not fill out any more of this form.  Go directly to the bottom of this form and click on the 'Continue' button.

Are you 18 Years or Older? Yes   No

Do you have experience working with people with cognitive/developmental disabilities? Yes     No
If yes, please explain:

Education:

Major and Degree: (if applicable)

Occupation: (Current or Prior Experience) (if applicable):

Current Employer:

Volunteer Experience: (Current or Prior Experience) (if applicable):

How did you become interested in Imagine!?

Describe your volunteer interests and goals:

Are you an individual volunteer or do you represent a group of volunteers? Individual  Group

What type of work are you interested in? Working directly with clients   Clerical Support   Other

If choosing to work with clients, what type of setting would you prefer?
Group Home
Community Based Day Program (theater, dance, painting, etc)

Please indicate any of the following skills or abilities that you possess. (Professional experience is not required). If you have other skills or abilities that might be valuable in working with Imagine!, please list them in the space provided.

Please indicate the days and time periods that you are generally available to serve. You may provide additional information regarding your availability in the space below.

I would like to volunteer times per month.

Each time I volunteer, I would like to work hours.

Additional Information Regarding Your Availability:

Please provide the following professional references (at least one is required):  

Have you ever been convicted of a felony? Yes   No
If yes, please explain:

Have you ever been convicted of any crime? Yes   No
If yes, please explain: