Volunteer Application

Volunteer Application

There are 3 ways to apply as a volunteer.
1) Apply Online using the form below
2) Print and Mail the Volunteer Form
3) Visit us at Epworth Villa

*Name:  
*Mailing address:  
*City:  
*State:  
*Zip:  
*Telephone:  
Mobile phone:  
Email address:  
*Emergency contact name:  
*Emergency contact telephone:  
*Relation:  
 
Tell us about organizations you belong to:
 
List any education, special skills, abilities, hobbies or interests that might help us find meaningful placement for you:
 
Tell us month, day and time preferences in which you could volunteer. We understand that travel, illness, and other activities will sometimes limit your participation:
 
Do you agree to abide by the rules and regulations of this facility?    Yes, I Agree    No, I Do Not Agree
 
References:
Please provide three (3) persons not related to you whom Epworth Villa is authorized to contact. Reference information is required.
Reference 1:
*Name:  
*Address:  
*Telephone:  
 
Reference 2:
*Name:  
*Address:  
*Telephone:  
 
Reference 3:
*Name:  
*Address:  
*Telephone:  
 
How did you hear about the Epworth Villa volunteer program and/or who referred you?
 
 
 
(*)Indicates Required Information