Name: Today's Date: / /
City, State, Zip:
Telephone Number: _________________________ Cell Phone Number:___________________________
School Attending: ___ Grade (circle one): 9 10 11 12
How many hours of Community Service are you seeking to fill at the Fletcher Library?
Community Service hours may be worked on weekdays before 5 p.m. when a supervisor is available. What days and times are you available to volunteer?
By what date is the Community Service to be completed?
Does verification of service completion need to be sent to an individual or organization?
(circle one) Yes No
If yes: Name: ____
What skills do you offer?
Do you have a means of transportation to and from the Library?
Have you discussed volunteering at the Library with your parent/guardian?
Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions. Library tasks require the ability to walk, talk, hear, sit, and reach. Occasionally volunteers lift and/or move up to 25 pounds. Specific vision abilities required include close and distance vision, peripheral vision, color vision, depth perception, and the ability to focus.
Parent/Guardian Signature: Date: / /