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3. 
6. LONGWOOD CITIZEN VOLUNTEERS
11. VOLUNTEER APPLICATION
13. Name*
14. Date of Birth*
16. Email Address*
18. Address*
20. City*
21. State*
22. Zip Code*
24. Phone Number
25. Cell Number
27. SPECIFIC AREAS OF INTERESTS (check one or more)

    1. CERT MEMBER
    2. COP MEMBER
    3. HOA & COMMUNITY MEETINGS
    4. RECRUITING
    5. CHAPLAIN CORPS

    1. RuOK PROGRAM (Courtesy Checks on Elderly)
    2. COMMUNICATIONS
    3. PHOTOGRAPHY/VIDEOS
    4. FUNDRAISING/DONATIONS
    5. VOLUNTEER COORDINATOR

    1. TRAINING & INSTRUCTION
    2. ADMINISTRATIVE/CLERICAL
    3. WRITING & PROOF READING
    4. VEHICLE & EQUIPMENT MAINTENANCE
    5. LCV OBSERVER MAGAZINE
29. AVAILABILITY TIMES

    1. MORNINGS
    2. AFTERNOONS
    3. EVENINGS

    1. WEEKENDS
    2. WEEKDAYS
31. Special Qualifications, Certifications & Skills:*
33. Previous Volunteer Experience:
35. EMERGENCY CONTACT INFORMATION
    (Person To Notify In Case Of Emergency)
37. Name*
38. Relationship*
40. Address*
42. City*
43. State*
44. Zip Code*
46. Phone Number*
47. Cell Number*
49. Work Phone*
50. Email Address
52. VOLUNTEER CONSENT AGREEMENT AND SIGNATURE
    By submitting this application, I hereby affirm that the information that I have provided is true and correct. I further understand that I may be required to undergo Drug Testing and a Background investigation as a condition of my acceptance in the Longwood Citizen Volunteer Organizations of which I am applying for. I further understand that any false or misleading statements, omissions, or other misrepresentations made by me on this application form may result in my immediate dismissal from the LCV Organization.
54. APPLICANTS SIGNATURE*
55. Date*
    Date
57. SPONSOR’S NAME*
58. Date*
    Date
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62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit Submit and Print

* indicates a required field