Test Form

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Employer & Occupation *

Availability

During which days and hours are you available for volunteer assignments? *

Interests

Tell us which areas you are interested in volunteering.

Special Events

Event Planning (Solicitation of in-kind donations, ticket sales, social media promotion)
On-site event work (Registration, live/silent auction monitoring, raffle sales)

Fundraising

Corporate/Foundation Grants (Connect the Verma Foundation with companies and foundations with open grant opportunities)

Patient Services

Hospital Outreach (Contact hospitals and medical facilities unfamiliar with the Verma Foundation, educating them on how we can help their patients)

Special Skills or Qualifications

Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports. *

Previous Volunteer Experience

Summarize your previous volunteer experience. *

Additional Information

Please check mark each that applies to you.

21 or older (you must be 18 or older to apply)
Access to a vehicle
Access to public transportation

Emergency Contact

Name *

First

Last

Phone *

Relationship *

References

Please list contact information for two people (excluding relatives) with whom you have worked or volunteered. We may contact your references.

Reference #1: Name *

First

Last

Reference #1: Phone *

Reference #1: Email *

Reference #1: Relationship *

Reference #2: Name *

First

Last

Reference #2: Phone *

Reference #2: Email *

Reference #2: Relationship *

Availability

Interests

Special Skills or Qualifications

Previous Volunteer Experience

Additional Information

Emergency Contact

References

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