Phone: (home) (work)(cell)    

E-mail Address:

Occupation:

 Times you are available to volunteer: (Please check all that apply.)

A)     B)

Any Day Anytime

Weekdays Morning

Weeknights Afternoon

Weekends  Evening

1)             Do you have a computer?             ---- Yes No
2)             Do you have MS Office programs?  ---- Yes No

                Version:         Word     Excel       Access        

Other Software:

3)             Do you have high speed (DSL or T1) internet access?   ---- Yes No
4)             Do you have free long distance phone service?             ---- Yes No
5)             How can you help? (Please check all that apply. For other ways to help, please see question #6.)

Data Entry	Phone Calls	Mailings
National Conference	Awareness	Typing Copy
Web site	Translation	(language:)

Other, please specify:

6)             Do you have talent/skill/education in an area that you think would benefit PWSA (USA)?

Graphic/Layout Design	Writing/Editing	Technology
Marketing/PR/Media	Project Management	Development/Fundraising
Resident Facilities	School Systems	Health Care
Advocacy/Government	Legal	Financial/Accounting

Other, please specify:

7)             Please describe in detail your skill sets and interests:

8)             Can we contact you as needed for projects?   ---- Yes No
9)             Would you like to volunteer for your state chapter, too? ---- Yes No
                (If yes, your name will be given to the state chapter.)    Your State Chapter:

Edited: 03/23/2010