Volunteer Application Please direct all questions to Anna Jensen at 919-915-9990 or firstname.lastname@example.org. North Carolina Farmworkers Project 1238 NC Hwy 50 S. Benson, NC 27504 Volunteer Application Name* First Last Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Why do you want to volunteer at the NC Farmworkers Project?*What programs interest you?Check all that apply Health program Affordable Care Act health insurance enrollment program Promoter program Special projects (i.e. English classes, donations, etc.) What projects or tasks interest you?Check all that apply Interpreting Translating documents (Spanish <−> English) Health education presentations Nutrition classes and/or education Transportation Developing health educational materials Administrative work (i.e. filing, organizing, etc.) Outreach to farmworker homes Survey collection and/or focus groups Seeking/collecting donations Farmworkers Project event support (dates TBD) Music classes English classes Other Other project or task that interests you: What skills or experience do you have that would benefit you as a volunteer with us?What is your level of English fluency?Select OneFluentAdvancedIntermediateBeginnerNoneWhat is your level of Spanish fluency?Select OneFluentAdvancedIntermediateBeginnerNoneDo you speak another language? If so, what is your level of fluency?Select OneFluentAdvancedIntermediateBeginnerNoneWhat other language? What days and times are you able to commit to volunteering? How often would you like to volunteer? For what duration (for how many days/weeks/months, etc.)?Do you have a reliable vehicle? Yes No Are you in agreement with using your vehicle for volunteer tasks such as visiting farmworker housing sites or collecting donations? Yes No Are you seeking volunteer hours to complete a requirement for school or work? Yes No If YES, how many hours do you need to complete? Are there other requirements that you need to fulfill?Please provide a personal or professional reference:Reference Name First Last Reference Relation Reference Email Reference PhoneEmergency Contact InfoEmergency Contact Name* First Last Emergency Contact Relation* Emergency Contact Phone*Volunteer AgreementAs a volunteer of our organization, I agree to abide by its policies and procedures. I understand that I will be volunteering at my own risk and that the organization, its employees, and its 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 the work I do is on a volunteer basis and I am not eligible to receive any monetary payment or reward.Signature*Date* NameThis field is for validation purposes and should be left unchanged.