Urban Ministries of Durham

Volunteer Form Name Address
City, State Zip ,

Work or Cell Phone Home Phone Employer or School Email Address Would you like to receive information about Urban Ministries via e-mail? Yes No

Highest Level of Education Completed

Special Training, Licenses, or Certifications

Skills, Talents, Hobbies

Other Volunteer Experience (How long, & what kind of work?)

Congregation and Civic Group Affiliations

Emergency Contact Name Emergency Contact Relationship Emergency Contact Phone

Are you seeking to fulfill organizational membership or class requirement? Yes No If so, what organization, or class and school? If there is time requirement, how many hours are you seeking to fulfill?

Volunteer Opportunities (Check all that really interest you) Day Receptionist (Answering phone and assisting visitors)
Special Event Organizing
Shelter Assistant (Distributing supplies and assisting staff)
Bulk Mail Assembly
Pantry/Closet Worker (Distribute, stock, and sort supplies)
Computer Data Entry
Kitchen Worker (Preparing & serving meals, clean-up)
Food Donation Pick-ups
Child-care (Supervising children at shelter for 1-2 hours)
Overnight Shelter Monitor
Building Maintenance: Plumbing
Building Maintenance: Electrical
Building Maintenance: Landscaping
Building Maintenance: Air-Conditioning
Other:

Frequency of Availability Weekly
Biweekly
Monthly
Occasionally:

Term of Commitment 6 months
1 year
Other:

Day of Week	Times Available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

If available only on specific dates, please list here.

Screening Information (ONLY required for working as childcare volunteer, shelter monitor, or driver. Be assured that we don't share any of this information.)

Birth Date (mandatory)

Have you been convicted of a criminal offense other than a traffic offense? Yes No If yes, please explain:

Have you had a driving violation in the last 5 years? Yes No If yes, please explain:

References:

Name:		Years Known:
Address:		Phone:

Name:		Years Known:
Address:		Phone:

Name:		Years Known:
Address:		Phone:

I affirm that the information I have provided is true and accurate to the best of my knowledge and recollection.

HERE IS HOW YOU CAN HELP RIGHT NOW

Donate
- UMD Budget Reaches $1.05 Million
- Easy Donations Through Your Workplace?
Volunteer
Donate Goods
Other Options
- Empty Bowls Poster
- Urban Ministries of Durham Fights Hunger with Empty Bowls Event