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First Name

Last Name

Home Phone

Cell Phone

Work Phone

Email

Alias or Maiden Name

Are you 18 years of age or older? (If no, you may be required to provide authorization to work.)

Yes

No

We do consider volunteers 16 – 18 years of age.

How did you hear about Schofield?

List any hobbies, special interests or skills you have or would like to share with our residents.

Preferred Contact Method

Availability

I'm interested in:

Activities Programs

Crafts/Creative Arts

Clerical Work/Filing

Data Entry

Entertainer

Escort to Doctor Appointments

Visitor/Reader/Letter Writer

Wheel Chair Transport

Internship/Service Learning

Additional Comments or Questions

If you need reasonable accommodation to participate in the volunteer process or perform volunteer activities, you may contact Human Resources at 716-684-3000 ext. 1317 (GreenFields Location) or 716-874-1566 x6322 (Schofield locations). Requests for accommodation are handled separately from this form and from volunteer selection decisions.

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