Perkins Volunteer Application

Please fill out the following form. You can also download a PDF version »

If you have any questions contact Mike Cataruzolo Volunteers@Perkins.org 617-972-7224

First Name (required)

Last Name (required)

Middle Initial

Street Address (required)

Apartment #

City (required)

State (required)

Zipcode (required)

Email (required)

Business Phone

Home Phone (required)

Emergency Contact

Emergency Contact First Name (required)

Emergency Contact Last Name (required)

Emergency Contact Relationship (required)

Emergency Contact Phone (required)

Education and Experience/Interests

High School (required)

Did you graduate (required)

College (required)

Degree granted (required)

Please describe your hobbies, interests, special skills or training (required)

Have you ever worked with people with disabilities (required)

Have you ever volunteered before?

If you have volunteered or worked with people with disabilities, please explain

Are you licensed/certified in

First Aid

CPR

Water Safety

Sign Language

Volunteer Availability

What hours are you available? (required)

If you would like to work directly with students and clients, please mark the preferred age group (required)

Are you available to volunteer for (required)

Please indicate your areas of interest in order of priority (required)

1st

Please indicate your areas of interest in order of priority2 (required)

2nd

Please indicate your areas of interest in order of priority3 (required)

3rd

Personal References

Please list name, address, and telephone number of two character references, not including relatives:

Reference1 (required)

Reference 1

Reference2 (required)

Reference 2

Signature (required)

Typing your full name serves as your signature.