Volunteer Interest Form

Name:

Address:

City

State

Zip

Work Phone:

Home Phone:

E-mail Address:

Number in Group:

Site Interest:

Youth Vision New Bern, North Carolina	Beulaville Youth Center Beulaville, North Carolina
Edgemont Community Center Durham, North Carolina	Straight Way Holiness Church Ayden, North Carolina
Avent Ferry United Methodist Raleigh, North Carolina	Homework Haven Raleigh, North Carolina
Western Blvd. Presbyterian Church Raleigh, North Caroilna	Salvation Army Boys & Girls Club Wilson, North Carolina

Volunteer Interest:

Tutoring	Meal Preparation
Educational Activities	Mentoring

When are you available to volunteer? Check all that apply:

Special Skills or Areas of Interest:

Any physical restrictions or special needs?

Contact Caprice Brown for more information on this page.