NAME :

ADDRESS :

CITY :       STATE :     ZIP :

HOME PHONE :    WORK PHONE :

E-MAIL ADDRESS :

DATE OF BIRTH :    SOCIAL SECURITY # :

YEARS OF EDUCATION :      SEX : Male Female

EMPLOYER :

How did you first become interested in working with ACES?

Have you ever volunteered for any other organizations?  Yes No

If yes, please indicate :

Any previous experience in working with the disabled? Yes No

If yes, please describe :

Do you have any knowledge or experience with computers? Yes No

 

With which computers are you most familiar? PC MAC

 

Are you familiar with the Internet? Yes No

If so, have you ever used Microsoft Internet Explorer? Yes No

Have you ever used email? Yes No

Do you have any knowledge of, or interest in computer repair? Yes No

Any experience with adaptive software for people with disablities? Yes No
If Yes, please describe :

5. Would you have difficulty relating to any type of client? Yes No

If Yes, please explain:

Time commitment. Please indicate how much time you would be willing to volunteer:

Hours Per Month:
Hours Per Week:

References. Please provide two references we may contact. Please do not list relatives.

Name : Phone number :

Name : Phone number :

Please indicate which of these areas would be of most interest to you:

Administrative

Volunteer tutoring (requires vehicle)

Computer installation (requires vehicle)

Computer repair

Publicity

Contribution Development

Contribution Pick Up (requires vehicle)

E-mail Newsletter

Do you have any physical limitations for which accomodations should be made? Yes No

If Yes, please describe :

Do you speak any languages other than English? Yes No

If yes, which languages?

Is there anything else about you that you would like us to know? If so, please describe here :