Volunteer Application

Thank you for your interest in Jeremiah Program. By completing the following application, you will help us provide the best match possible for your talents, interests and gifts.

First Name *
Middle Name *
Last Name *
Email *
Address *
City *
State *
Zip *
Employer *
Position
Work Phone
Home Phone *
Cell Phone
Gender  Male Female
Date of birth
Partner/Spouse
Contact, in case of emergency
Name:
Phone:
Relationship:
Interests (check all that apply)
 Bullfrog Bash Caring for Kids Cook for Kids Hospitality Jeremiah Journey JETs (Jeremiah Events Team) Life Skills Facilitators Tutor Welcome Baskets
Other:
Preferred location to volunteer:

 Minneapolis St. Paul Minneapolis and St. Paul Fargo-Moorhead Austin
Are you able to make an ongoing commitment?

 yes no
Education
High School / GED:
Level / year completed:
Field of Study:
 
College:
Level / year completed:
Field of Study:
By submitting this application, I:
  • Give my permission to Jeremiah Program to conduct a background check at the Department of Human Services, as required for service.
  • Acknowledge that my volunteer service to Jeremiah Program may involve some risk of physical injury, and release Jeremiah Program, their employees and agents from all claims or causes of action arising from accident or injury that may occur while I am volunteering.
  • Agree that Jeremiah Program may use photographs and/or videos of me for publicity purposes.
  • Agree that any materials or creative works developed by me as a volunteer shall remain the sole property of Jeremiah Program.

    • Acknowledge my understanding that Jeremiah Program staff has the right, in its sole discretion, to place or not place me in a volunteer position.

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Volunteer

Make An Impact

A Monthly Gift of just $25 enables classroom materials, Life Skills coaching, secure campus housing, and on-site Child Development Centers. Register for a recurring gift online today.

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