[Town of Wellesley] COA Volunteer Application Web Form

Please fill in days/times you are available to volunteer. Most volunteer needs are during COA business hours. The Center is open Monday through Friday from 9am to 4pm; with extended evening hours on Wednesday until 7:00 pm.

Availability

I Prefer To Work:

Regular Schedule

Intermittently

Specify any particular date/time of the year that may impact your availability.:

Opportunities / Activities

THE WAYS I AM WILLING TO HELP (Check all below that apply):

Opportunities

Other ways I am willing to help (list your unique ideas of services to provide here):

Volunteer instructor/facilitator: Please list subjects you are interested in leading a discussion on:

Interpreter/Translator services: List any languages you are proficient in if you wish to provide this service

How did you learn about volunteering with the COA?

Other Qualifications

Is there any other information you would like us to know?

Please list two people who know you well and can attest to your character, skills and dependability. Please do not include family members.

Reference 1: Name and organization

Reference 2: Name and organization

The Council on Aging is open from 9:00am to 4:00pm with occasional evening and weekend programming. Applicants age 18 and over will be required to complete a CORI Request consent form and provide one of the following government-issued forms of identification: driver's license, passport, state-issued identification card with photograph, or military ID. This verifies your identity and is required before beginning any volunteer engagement.

Your signature below indicates our agreement with the following statement: By typing my name in the following box and clicking submit button, I certify the above statement to be true and correct, to the best of my knowledge.

Applicant Name (print):

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Click on the Submit button to the right to electronically submit your application.

Completed forms will be delivered to:

Sally Miller, Volunteer Coordinator

Wellesley Council on Aging

500 Washington Street, Wellesley MA 02482

Email: smiller@wellesleyma.gov

Phone: 781-235-3961

Thank you for expressing your interest in volunteering with the Wellesley Council on Aging! We will reach out to you if we have any further questions or if we have any available volunteer opportunities that match your qualifications.

For Internal Use Only

Please do not write below this line

Follow up/interview	____________	CORI Processed	__________
Interest	____________	MSC Input	__________

Town of Wellesley

COA Volunteer Application

Volunteer Contact Information

Person to Notify in Case of Emergency

Education and Experience

Availability

Commitment of Time

Opportunities / Activities

How did you learn about volunteering with the COA?

Other Qualifications

References

Applicant Signature

For Internal Use Only