Name: ________________________________
Address: ______________________________
City: __________________________________
State: ___________ Zip: _________________
Phone (home): ________________________
Phone (work): _________________________
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Date: __________________________________
Birth Date: ____________________________
Time Available: _______________________
Hours: ________________________________
How Informed: ________________________
Special Projects: _______yes _______no
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Please Check All That Apply
Skills:
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___Adult Tutoring
___Board Member
___Committee member
___Flyer/Ad Design
___Grocery Shopping
___Interviewing
___Mechanics/Auto
___Mentor Mom
___Painting
___Physical Labor
___Snow Shoveling
___Transportation/In Town
___Visiting Companion
___Youth Supervision
___Assist Youth Sports
___Carpentry
___Data Entry
___Foreign Language
___Help Move/Have Truck?
___Lawn Work
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___Mentor Child
___Musician
___Phone Work
___Public Relations
___Teach a Craft Skill
___Transportation/Out of Town
___Word Processing
___Auditing
___Coach Youth Sports
___Filing
___Grant Writing
___Housekeeping
___Maintenance
___Mentor Disabled
___Newsletter Writing
___Photography
___Reception
___Telephone Support
___Typing
___Youth Tutoring
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No Obligation!
United Way & Volunteer Services
P.O. Box 387, Yankton SD 57078
605-665-6766 231 Broadway
unitedway@iw.net
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