Name:
Address:
City:
State:
Zip:
Home Phone:
Email:
Employment
Job Description/Title:
Employer:
Employer Phone:
Employer Fax:
Employer Email:
Type of agency you would be interested in serving as a board member:
[ ] Health
[ ] Recreation
[ ] Elderly Services
[ ] Civic
[ ] Education
[ ] Faith Based
[ ] Substance Abuse
[ ] Women's Issues
[ ] Mental Health
[ ] Cultural
[ ] Youth
[ ] Environment
[ ] Volunteerism
[ ] Other
Your Talents:
Your Interests:
Please check all that are appropriate:
Your background:
[ ] Corporate
[ ] Homemaker
[ ] Student
[ ] Retiree
[ ] Management
[ ] Trades
[ ] Union
[ ] Media
[ ] Accounting
[ ] Marketing
[ ] Sales
[ ] Planning
[ ] Financial
[ ] Public Speaking
List of organizations to which you currently belong:
Attach your current resume and current biography with this completed form. This information enables us to make the most effective match for you.
Top of Page
58 Division Street | Danbury, Connecticut 06810 phone: (203) 797-1154 | fax: (203) 797-1194 volunteers@volunteerdanbury.org
Copyright © 2008 The Volunteer Center serving Western Connecticut
