Consolidated Form - Inclusion Connections

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Verification

Consent*

I verify that I am not seeking Court-Ordered Community Service Hours.

NOTE: we are unable to accept volunteers who seek Court-Ordered Community Service hours.

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General Information

Type of Application*

Please select only one!

Name*

First Last

Email*

Phone*

Address*

Residence Address (For Group Volunteers, use Company Address)

Street Address Address Line 2 City State ZIP Code

Gender*

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Peer Volunteers

Parent Name*

Parent or Guardian Name

First Last

Parent Phone*

Parent or Guardian Phone

Parent Email*

Parent or Guardian Email

Alternate Contact Name

First Last

Alternate Contact Phone

Date of Birth*

Peer Date of Birth

School*

School currently attending

Clubs

List any clubs or sports you have participated in

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Group Volunteers

Company Name*

Company Description*

If so, please provide contact information for the person we should talk with.

Number of Employees*

Please provide the approximate number of employees your company has in the KC Metro area.

Number of Volunteers*

Approximate number of volunteers in your group

Mobile Store*

The PawsAbilities Mobile Store visits local businesses, offering your employees opportunities to purchase Paws treats and other products. It's also a teaching tool where Paws trainees learn customer service skills. Would your company be interested in having the Mobile Store visit?

More info

If your answer to the question above was "Yes", please provide Contact info for the person who would arrange details for a Mobile Store visit.

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Board of Directors

Ethnicity*

Caucasian
African American - Black
Hispanic - Latino
Asian
Native American
Mixed Race

This field is for Grant Reporting Only. You may select more than one.

Committees*

List boards/committees you serve(d) on (business, civic, community, fraternal, political, professional, recreational, religious, social). List Organization Name, Your Role/Title, and Dates of Service

Education*

List Education/Training/Certifications

Awards*

Have you received any awards/honors you'd like to mention

Advocacy*

List any groups, organizations or businesses that you could serve as a liaison to on behalf of Inclusion Connections.

Benefit*

How do you feel Inclusion Connections would benefit from your involvement on the Board?

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Intern College

College*

Name of college currently attending

Major*

Give your Year in School and Major (e.g. Junior, Accounting OR Sophomore, Health Sciences)

Intern Area*

Working with job training program for participants
Working with healthy living program - e.g. cooking, nutrition, exercise
Working with arts program
Working with business side of IC - acctg, mktng, nonprofits, fundraising, etc.

Select all areas you are interested in.

Position*

Other Information

Current Employer*

Occupation*

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Ways to Volunteer*

Making dog treats - toys with participants
Assisting with sewing projects
Office - data entry, acctg, organizing, cleaning, organizing, misc.
Teaching a class
Helping organize an event
Volunteering at an event - e.g. fundraising event, Holiday Boutique, or Farmers Market

Please check all ways to volunteer which interest you.

Times Available*

Days
Evenings
Weekends
Anytime

You may select more than one.

Dates available

List any date(s) you prefer to volunteer.

Volunteer Source*

How did you learn about Inclusion Connections?

Volunteer Organizations

List any organizations where you have volunteered

Skills*

List your skills, hobbies, areas of interest

Other Info

Tell us anything else we should know about you or your areas of interest.

Waiver*

You must accept the IC Waiver to be considered for participation.
You can view the IC Waiver in a new window.

I have read and understand the Waiver Statement above.

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Verification

General Information

Peer Volunteers

Group Volunteers

Board of Directors

Intern College

Other Information

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