Volunteer Application Form
Personal Details
Name: __________________________________________ Mr.  Mrs.  Miss.  Ms. 
Postal Address:
____________________________________________________________________
Nationality: __________________________
Telephone: (Home) ____________________
(Mobile) ________________________
E-Mail: __________________________________________
Birth-date: _______________________________________
Day / Month / Year
Blood Group
A+
A-
B+
B-
O+
O-
AB+
AB-
During your volunteering service with us if any emergency arises, whom should we contact?
Name: _______________________________________ Relationship: _______________________
Telephone: (Home) _________________________
(Mobile) _______________________
Your Skills and Interests
1. Have you ever done any voluntary work before?
Yes 
No 
If you answered yes, please tell us a little about the experience.
2. Why do you want to volunteer now? What has motivated you to get in touch with us?
3. Do you have any particular skills or qualities that you could use in your voluntary work?
5. What kind of voluntary work interests you?
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Serving children inside the Oncology ward
Help to find the Blood donors while needed for children in emergency
Fundraising programs
Project Based Volunteering
Other
6. When are you available for voluntary work?  Totally Flexible
Monday
Tuesday
Wednesday Thursday
Friday
Morning
Afternoon
Evening
7. How long do you plan on volunteering? 
(A minimum time commitment is required)
Saturday
Sunday
30 days  60 days  90 days  other
8. How many hours per day do you intend to volunteer for?
(A minimum time commitment is required)
9. Where do you wish to volunteer? _________________________
(Counseling centre /Hospital)
10. How did you find out about volunteering with Educate Together?
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Information / Outreach meeting
From Elders/friends circle/Parents/Teachers
Leaflet / Poster
Internet www._______________________
A Volunteer Centre
Media: Radio / Television / Newspaper
Other ____________________
If you have any queries when completing this application form, please feel free to call or e-mail us.
Is there any additional information you would like to bring to our attention?
I declare that the information I have provided is true. All my actions as a volunteer will reflect the
ethos of Dirghajeevi voluntary Group and I agree that while volunteering among the cancer battling
children, will not act any discriminatory behavior with children and their parents according to their
ethnicity, races, caste, religion, birth defect and any other physical, mental or emotional appearance.
_____________________
Signature
_____________________
Date