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Volunteer Application 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 Info
2
General Info
3
References
4
Affirmation & Code of Ethics
5
Signature
Name
*
First
Last
Are you 18 or older?
*
All Chicago Lighthouse volunteers must be 18 or older to participate.
Yes
No
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
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Iowa
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Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Nevada
New Hampshire
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New York
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Ohio
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
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Vermont
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Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
*
Phone
*
Birth Date
MM
DD
YYYY
Would you like to be added to our mailing list?
*
Yes
No
Occupation
*
Employer / School
*
Have you completed volunteer work previously?
*
Yes
No
Please comment on prior volunteer experience, skills, special training, interests, etc.
If accepted for volunteer services, please choose the programs/positions you would be interested in serving:
CRIS Radio, Reader
Seniors Program, Liaison
Adult Living Skills, Assistant
Adult Living Skills, VisionQuest Liaison
Front Desk, Greeter
Employment Services, Interviewer for Mock Interviews
Special Events
Other
Do you have any health restrictions that would affect your ability to carry out volunteer opportunities?
If yes, please discuss possible accommodations with the volunteer coordinator prior to beginning your assignment.
Days available to volunteer
*
Most volunteer opportunities are available M-F, 9 a.m. – 3 p.m. with the exception of special events.
Monday
Tuesday
Wednesday
Thursday
Friday
Weekend
No Preference
Times available to volunteer
*
Most volunteer opportunities are available M-F, 9 a.m. – 3 p.m. with the exception of special events.
Morning (9 a.m. – noon)
Afternoon (1 – 4 p.m.)
Evening (5 – 8 p.m.) SPECIAL EVENTS ONLY
No Preference
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
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
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Saint Lucia
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Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
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Sierra Leone
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Sint Maarten
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Slovenia
Solomon Islands
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Sudan, South
Suriname
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Sweden
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Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
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
*
Please fill out
THIS FORM
and upload it below to continue.
File
*
Please fill out
THIS FORM
and upload it below to continue.
File
*
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
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