ZESST Volunteer Application

 
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General Information:

First Name:
Last Name:
Preferred Name:
Date of Birth: (MM/DD/YYYY)
Student ID#:
Preferred Email:
Cell Phone: (XXX-XXX-XXXX)
Address:
Address (cont.):
City:
State:
Zipcode:
MSC #
Select year in school:
Major:
Gender: Male
Female
Other
Prefer not to answer
Ethnicity (optional):
GPA:
T-Shirt Size:
Food Allergies/Preferences: Please check all that apply:
I am a vegetarian
I am a vegan
I am gluten intolerant/sensitive
I have a peanut allergy
I am allergic to dairy/lactose intolerant
other:

List all commitments you anticipate having next year (Extra-curricular, leadership positions, jobs, etc.):

Application Question
In 1-2 paragraphs, please explain why you want be a ZESST volunteer. Topics can include (but are not limited to): what has motivated you to connect with seniors, what unique skills you can bring to the program, and/or what role you plan on playing as a ZESST volunteer.
 

Availability:
Will you have a car? Yes No
Do you have proof of car insurance? Yes No

If selected as a volunteer for this program do you agree to attend:
Yes No - Weekly Programming
Yes No - Training and Reflection Activities
Yes No - Other events as assigned
 
Please note that the program is filled on a first-come, first-serve basis and may close before the deadline if all available spots have filled.
Notes:
 

History with the Program:
Are you a returning volunteer to ZESST? Yes No
Have you participated in a different program within CCASL? Yes No
If yes, which one(s)?
 
I understand that any information I provide during this application process will be used to determine my eligibility to participate. I consent to the release of my information for this purpose.*