Volunteer Interest Form

Completion of this form is the first step in the volunteer application process to become a Chicago Lighthouse volunteer. Upon receiving your form submission, our volunteer coordinator will contact you within two weeks to follow up.

1 Basic Information

2 General Questions

3 Personal and/or Professional References

Name*

First

Last
Are you 18 or older?*
All Chicago Lighthouse volunteers must be 18 or older to participate.
Address*

Street Address

Address Line 2

City

State

ZIP Code
Email*
Phone*
Birth Date

MM

DD

YYYY
Would you like to be added to our mailing list?*
- Yes
- No

Save and Continue Later

Please list an emergency contact:
Emergency Contact Name*

First

Last
Emergency Contact Phone*
Emergency Contact Email
Emergency Contact Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Reference #1
Reference #1 Name*

First

Last
Reference #1 Email
Reference #1 Phone*
Reference #2
Reference #2 Name*

First

Last
Reference #2 Email
Reference #2 Phone*
Reference #3
Reference #3 Name

First

Last
Reference #3 Email
Reference #3 Phone*
Signature*
By entering my name below, I acknowledge that the information I provided here is accurate to the best of my knowledge.

First

Last
Date*

MM

DD

YYYY
Name
This field is for validation purposes and should be left unchanged.

Save and Continue Later

Please list an emergency contact:

Reference #1

Reference #2

Reference #3

Related Links

Veterans Login