Volunteer Application

Thank you for taking the time to complete the information below. The information will be used to assist in finding a site and supervisor for your experience at Harry Meyering. For information regarding volunteer opportunities, contact Anna Olson, Coordinator of Community Connections 109 Homestead Rd Mankato, MN 56001 (507) 387-8281 ext. 259.

If you would prefer to print the application please Click Here

Volunteer Application

PERSONAL INFORMATION

First Name *

Last Name *

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe

Country

Email Address *

Primary Phone Number *

Secondary Phone Number

Gender *

Male

Female

You are responsible for your own transportation. Do you have a car? *

Yes

No

If you do not have a car, do you have other ways to get to the site to which you are assigned?

Yes

No

Explain

EMERGENCY CONTACT

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Phone Number *

SCHOOL INFORMATION

Are you volunteering for a class *

Yes

No

School

Class

Class Instructor

Instructor Email Address

Number of Hours Needed

AVAILABILITY

Desired Start Date *

Desired End Date

Times Available:

Monday Start Time

121234567891011 : 0030 AMPM

Monday End Time

121234567891011 : 0030 AMPM

Tuesday Start Time

121234567891011 : 0030 AMPM

Tuesday End Time

121234567891011 : 0030 AMPM

Wednesday Start Time

121234567891011 : 0030 AMPM

Wednesday End Time

121234567891011 : 0030 AMPM

Thursday Start Time

121234567891011 : 0030 AMPM

Thursday End Time

121234567891011 : 0030 AMPM

Friday Start Time

121234567891011 : 0030 AMPM

Friday End Time

121234567891011 : 0030 AMPM

Saturday Start Time

121234567891011 : 0030 AMPM

Saturday End Time

121234567891011 : 0030 AMPM

Sunday Start Time

121234567891011 : 0030 AMPM

Sunday End Time

121234567891011 : 0030 AMPM

PLEASE ANSWER THE FOLLOWING QUESTIONS

Why did you choose Harry Meyering as your site? *

What experiences have you had with people with developmental or physical disabilities? *

What do you hope to gain from your experience at Harry Meyering? *

How did you find out about this opportunity? *

SKILLS, INTERESTS, AND HOBBIES

Please check all that apply to you.

Music

Dancing

Instrument

Listening to music

Singing

Writing music

OtherOther

Electronic / Video Games

Computer

Wii

Playstation

Xbox

OtherOther

Movies

Cartoon

Drama

Mystery

Romantic

Scary

OtherOther

Art/Crafts

Bead work

Candle & soap making

Clay pots

Cross stitch

Design

Drawing/Sketching

Jewelry making

Knitting

Latch hook

Models (cars, ships, etc.)

Needlepoint

Painting

Pottery

Quilting

Rubber

Stamping

Scrapbooking

Sewing

Smocking

Woodworking

OtherOther

Sports (play or are interested in)

Baseball

Basketball

Bocce ball

Bike riding

Bowling

Boxing

Catch

Cricket

Darts

Exercising

Fishing

Foosball

Football

Frisbee

Golf

Go-carting

Hockey

Horse racing

Horseback riding

Ice skating

Pool

Ping-pong

Roller skating

Rugby

Running

Soccer

Softball

Swimming

Tennis

Track & field

Walking

Water skiing

OtherOther

Recreation/Likes

Amusement parks

Bird watching

Boating

Bingo

Canoeing

Camping

Casino

Church

Circus

Collections

Concerts

Cooking/Baking

Decorating

Dice games

Fairs/carnivals

Farming

Feed animals

Flowers

Fly kites

Gardening

Garage sale

Going out to eat

Go to a club

Hiking

Home repair/remodeling

Hunting

Jet skiing

Journaling

Lottery tickets

Library

Museums

Playing games (e.g. Chess)

Parks

Parades

Picninc

Photography

Plays

Puzzles

Reading

Religious Study

Rodeo/horse show

Shopping

Sledding

Snorkeling

Snowmobiling

Traveling

Vacations

Visiting animal shelters

Visiting gardens or nurseries

Volunteering

Watching TV

OtherOther

Anything else you'd like to share?

If you are human, leave this field blank.