To become an Epiphany House Volunteer, please complete the form below then select the Sign Me Up! button. The information you provide will help us find the best possible match for you in our volunteer program

Name:	Mr. Mrs. Ms. Miss
Address:
City:	State: Zip:
Home Phone:	Date of Birth:
Work Phone:	Spouse's Name:
E-mail Address:
Education Completed:	(Please select from list) High School: 9th grade High School: 10th grade High School: 11th grade High School: 12th grade College: 1 year College: 2 years College: 3 years College: 4 years Degree:
Please describe previous volunteer experience (where, when, how long):
How much time can you give? weekly monthly
Areas of Interest:	Child Care Medical Fund Raising Dental Transportation Law Clerical Teaching Buildings/Grounds Computer Other:
Other Interests, Skills, or Hobbies:
Person to Contact in case of emergency: Name: Phone:
How did you hear about Epiphany House?