Volunteer Application Name* First Middle Last Date of Birth* MM slash DD slash YYYY 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 Cell PhoneEmail* Are you a current student at SAU?* Yes No Place of Employment and Job TitleT-Shirt Size* Small Medium Large XL 2X 3X Do you reside outside of town and require housing? Yes No Please indicate the camp(s) for which you plan to volunteer?* MKC - June 24 - 27, 7:45 am - 5:15 pm MTC - July 15 - 17, 9:30 am - 5:30 pm Are you volunteering for MKC/MTC as a part of a student organization?* Yes No For which student organization are you volunteering?*Emergency ContactEmergency Contact Name* First Last Relationship*Phone*Background CheckThe following information is required for a background check. By submitting the form, you authorize Southern Arkansas University to obtain a background check for the purpose of teaching and/or volunteering for Mulerider Kids College at Southern Arkansas University.Gender Male Female Race White (non-Hispanic origin) Black (non-Hispanic origin) American Indian or Alaska Native Asia or Pacific Islander Hispanic Non-resident alien Driver's License Number*State of Driver's License*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificSocial Security Number*Have you ever been arrested or charged with anything other than a minor traffic violation?* Yes No Please explain.*Experience and QualificationsPlease list any past experience with volunteering.Please list any special skills or qualifications that you feel would make you an asset to Mulerider Kids College. Include any hobbies that you enjoy or sports you are involved with to help us place you with a class that best fits your interests.AgreementBy submitting this application, I state that the information above is accurate. I understand that if I am chosen as a volunteer, misrepresentation of any type made in this application may result in my immediate dismissal.Mulerider Kids College PolicyIt is the policy of the Mulerider Kids College to provide for and promote equal opportunity without discrimination based on age, race, color, national origin, gender, sexual orientation, or disability. Δ
