We encourage you to fill this form out online and send it to us using the "Submit Application" button at the bottom of the page.
If you prefer to print it first, please return this completed application by mailing it to:
Association for the Blind & Visually Impaired Attention: Joy Wahby 456 Cherry SE Grand Rapids, MI 49503
For more information, please call Joy Wahby at 616-458-1187 or 1-800-466-8084 or email at abviadmn@abvimichigan.org.
* means required fields
Name *
Street Address *
Street Address 2
City, State, Zip *
County
Daytime Phone *
Evening Phone Number *
Emergency Contact Name *
Emergency Contact Phone Number *
If you are under 18 years old, do you have a work permit? Yes No
Have you ever been convicted of a crime? Yes No *
If yes, please describe the charge for which you were convicted, the date of the charge and the location:
High School:
College
Other
Do you speak other languages (than English)?
What important things should we know about you?
Previous experience working with visually impaired?
Describe any previous volunteer experience
When are you able to volunteer? Weekdays Weekends Daytime Evening
Agency Services Receptionist File Assistant / Clerical Braille Dept Community Education / Speaker
Client Services Reader Driver Shopper / Aide
Special Events Committee Member Event Worker Mailings (stuff envelopes)
Name of Company:
Supervisor:
Address and Zip:
Employer Phone:
Tell us about your work
Name: *
Address and Zip: *
Reference Phone: *
By signing this application, I certify that the statements made by me are true and complete to the best of my knowledge. I understand that false statements herein are sufficient grounds for rejection of this application and/or dismissal. I also acknowledge the agency's policies on confidentiality and will treat all information about clients with strict confidence. I understand that client information must be protected from the possible consequences of being inappropriately released. Violation of client trust is cause for immediate dismissal Inquiries from the news media should be referred to the immediate supervisor or any ABVI staff member.
Please understand that all volunteers must pass a background check. More details will be given when interviewed.
I Agree Yes No *
Thank you for submitting your application.
