Thank you for your interest in becoming
a volunteer at Lifting Up Westchester!

Please fill out this form in its entirety to be
considered for volunteering at our agency. 

Incomplete forms will not be considered.

Applicant's Name *
Applicant's Name
Birthday *
Birthday
Address *
Address
Cell Phone
Cell Phone
Alternate Phone
Alternate Phone
If yes, please describe.
If you're a current LUW Volunteer, when did you begin?
If you're a current LUW Volunteer, when did you begin?
Emergency Contact Information
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone Number *
Emergency Contact Phone Number
Are You Under 18? *
Are You At Least 14 Years Of Age? *
Parent/Guardian's Name (if under 18)
Parent/Guardian's Name (if under 18)
By filling out this line, you certify that this document was reviewed and approved by a parent/guardian.
Available Dates (Please List Days and Times)
Will You Require An Accounting Of Your Volunteer Hours? *
Are You Volunteering As Part Of A Mandated Service Requirement? *
Name Of Parole Officer/Attorney Overseeing Hours
Name Of Parole Officer/Attorney Overseeing Hours
Phone Number
Phone Number
Have You Ever Been Convicted Of A Felony? *
A conviction record will not necessarily be a bar to volunteering. Factors such as age at time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into consideration.
Please list the NAME, RELATIONSHIP, COMPANY, PHONE NUMBER, ADDRESS, AND EMAIL for TWO references below. Partially filled out references information will not be considered.
IMPORTANT INFORMATION TO READ PRIOR TO FILLING OUT THE REST OF THE FORM
1. A background check will be conducted if you volunteer to work with children. 2. All minors must be at least 14 years of age to participate in most activities. 3. Young adults between the ages of 16 and 18 must be accompanies and supervised by a parent/guardian when volunteering in Grace's Kitchen Dining Hall and only with prior permission from Lifting Up Westchester.
Brighter Futures Mentoring
Please check all programs that are of interest to you
Brighter Futures Summer Camp
Please check all programs that are of interest to you.
Rainbow Outreach For Developmentally Disabled Children and Adults
Homeless Program/ Grace's Kitchen
Please check all programs that are of interest to you.
Maintenance
Office
General Help
Signature and Date
Signature *
Signature
Today's Date *
Today's Date