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ILP Volunteer Interest Form
Content
Independent Living Program Volunteer Interest Form
Independent Living Program Volunteer Interest Form
Thank you for your interest in volunteering with the Senior Companions Program, part of the City of Jacksonville's Independent Living Program. Please complete the form below fully, and a staff member will reach out to you to discuss volunteering in further detail!
Name:
Please include your first and last name...
Street Address:
City:
State:
AL
AK
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MO
MN
MS
MT
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ND
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NH
NJ
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NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
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WV
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U.S. ZIP code:
Main Phone:
(
)
-
Second three digits
Last four digits
This is a:
Home Phone
Cell Phone
Other
Alternate Phone:
(
)
-
Second three digits
Last four digits
Email:
Gender:
Male
Female
Veteran:
Yes
No
Bilingual:
Yes
No
(If yes) Language:
Special Accommodation Needed?:
Yes
No
Transport:
Own A Car
Public Transportation
None
Availability (Select All That Apply):
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Volunteer Area (Select Any):
Northwest/Oceanway
Southside/Mandarin
Westside/Maxville
Riverside/Murray Hill
Are you able to work 15 hours/week?:
Yes
No