Prairie Creeks Living Center and

The Residences at Prairie Creeks

Managed by Eastern Slope Housing, Inc., a Colorado Not-for-profit 503C
Volunteer Application
Eastern Slope Housing, Inc. encourages the participation of volunteers who wish to help enrich the lives of our residents. If you are
willing to be interviewed and trained in our procedures, we encourage you to complete this application and return it. The
information on this form will be kept confidential and will help us find the most satisfying and appropriate volunteer opportunity for
you. Thank you for your interest in our organization.
Name: ___________________________________________________________________________________________
Address: ___________________________________________________________________________________________
Phone: ___________________________________Email:____________________________________________________
Date of Birth: ______________________________

Please share any special talents or skills you have that may benefit our organization:
__________________________________________________________________________________________________
__________________________________________________________________________________________________

Please Indicate Your Availability (example 12:30 to 3:30 pm)

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning
Afternoon
Evening

How often would you like to volunteer? 1 shift weekly 1 shift biweekly 3 or more shifts/week
Other______________
How long of a commitment are you prepared to make? 6 months 1 year Ongoing
Are you receiving academic credit for your volunteer work? Yes No Hours Required___________
Do you have any physical limitations? Yes (please describe below) No
__________________________________________________________________________________________________
________________________________________________________________________

Please list two references that are not family members or personal friends:
1. Name:_________________________________________________________Phone :_______________________
2. Name:_________________________________________________________Phone :_______________________

I hereby authorize Eastern Slope Housing to contact the above named reference to establish my suitability as a volunteer. As a volunteer of
Eastern Slope Housing, I agree to abide by the policies and procedures set forth. I understand that I will be volunteering at my own risk and that
the organization, its employees, its residents and affiliates, cannot assume any responsibility for any liability for any accident, injury or health
problem which may arise from any volunteer work I perform for the organization. I agree that all work I perform is on a volunteer basis and that I
am not eligible to receive any monetary payment or reward. I also understand and respect the confidential nature of the information I may have
access to in performing my volunteer duties for Eastern Slope Housing. Disclaimer: It is the policy of Eastern Slope Housing to screen all
prospective volunteers. While we try to place every applicant, we reserve the right to select applicants according to our needs and criteria.

Signature of Applicant:_______________________________________________________________Date:__________________________________

Parental Consent (for those under 18 years of age) and consent for tuberculin skin test:

I give ________________________________________________________________________________my consent to work as a volunteer for Eastern Slope Housing.

Parents Signature:____________________________________________________________________________Date:________________________________________
Once completed, please fax your application to 303-622-6263