TYPE OF OPPORTUNITY *---IndividualCorporate
COUNTY *---San BernardinoSan DiegoRiversideImperial County
FOCUS AREA *---AdministrationEarly Childhood Development
FOCUS AREA *---AdministrationSupportive HousingBehavioral Health
FOCUS AREA *---Senior Housing
FOCUS AREA *---Early Childhood DevelopmentAdministration
FOCUS AREA *---Early Childhood Development
FOCUS AREA *---Supportive HousingBehavioral Health
FOCUS AREA *---Supportive Housing
SERVICE OPPORTUNITY *---Clerical
SERVICE OPPORTUNITY *---Classroom AssistanceGuest ReaderAfter School Assistant
SERVICE OPPORTUNITY *---After School TutoringGuest Reading Program
SERVICE OPPORTUNITY *---TransportationCookingCounseling
SERVICE OPPORTUNITY *---Art ClassesMaintenanceGardening
SERVICE OPPORTUNITY *---Facility Improvement ProjectsGrounds Improvement ProjectsSponsor a picnic or BBQ cookout
SERVICE OPPORTUNITY *---Building Improvement ProjectsGrounds Improvement ProjectsSponsor a picnic or BBQ cookout
SERVICE OPPORTUNITY *---Arts & CraftsGardeningFitnessVisiting/Companion
SERVICE OPPORTUNITY *---Music/EntertainmentSocialization EventsShopping for Pantry EssentialsGrounds Improvement ProjectsFacility Improvement Projects
SERVICE OPPORTUNITY *---Classroom AssistanceGuest ReaderAfter School ProgramAssistance
SERVICE OPPORTUNITY *---Operation Back to SchoolBack Pack Give AwayFamily Health Fair
FIRST NAME*
LAST NAME*
DATE OF BIRTH*
MAIN ADDRESS TYPE *HouseApartmentOther
STREET ADDRESS*
CITY*
STATE* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
ZIP*
HOME COUNTRY*
MOBILE PHONE*
EMPLOYER *
WORK ADDRESS *
CITY *
STATE *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
ZIP *
WORK COUNTRY *
WORK PHONE *
GENDER Select OneMaleFemaleOtherPrefer not to say
ETHNICITY Select OneAfrican-AmericanAsian/Pacific IslanderHispanic/LatinoNative AmericanWhiteMulti-RacialOther
EDUCATION LEVEL Select OneSome high schoolHigh school graduateSome collegeTechnical/Associate degree4 year college degreeGraduate DegreeOther
MARITAL STATUS Select OneSingleMarriedPartneredDivorcedWidowed
EMPLOYMENT STATUS Select OneFull TimePart TimeNot EmployedRetiredOther
DISTANCE WILLING TO TRAVEL Select OneWithin 1 mileWithin 5 milesWithin 10 milesWithin 20 milesWithin 30 miles
HOW DID YOU HEAR ABOUT US? Select OneWebsiteSearch EngineFacebookFamily of FriendEmail/NewsletterOther
DO YOU CONSIDER YOURSELF A PERSON WITH A DISABILITY? NOYES
PLEASE CHECK IF YOU WANT TO HELP IN A DISASTER? NOYES
