I want to work with United Way to help improve lives and strengthen our community!
Name

Home Address

City State Zip

Email (personal) Phone (Home)

Employer

Work Address

City State Zip

Email (Work) Phone (Work)

Referred by

I prefer to be contacted at: ? Home ? Work by: ? Email ? Phone ? Mail

I’m interested in more information about these opportunities: (please check one or more)
Project Blueprint
Day of Caring
Young Leaders Society (YLS)
Site Review and Allocation
Outreach Committees
Special Projects at United Way
Individual Volunteer Opportunities at United Way partner agencies
No preference
Other____________________________________

I prefer to lend: my leadership my labor whatever is needed

I am employed: full-time part-time retired

Do you have access to a car? Yes No

I prefer to work in: Chicago North South West Loop

Suburbs North South West

I am available: Mornings Afternoons Evenings Weekends

I prefer to work with: Children/Youth Adults People with disabilities Seniors

Please indicate skills you have:
Clerical
Fundraising
Computers
Maintenance
Data entry
Marketing/PR
Finance/Accounting
Program review
Strategic Planning
Other____________________________________

Have you volunteered with United Way before?
Yes
No

Demographic Information:
(please check one or more) Asian Pacific American Latino African American Caucasian
Native American Other____________________________________

Age: 18-29 30-40 41-59 60 and above

Education: High School/GED Some college Bachelor’s Master’s Doctorate

Gender: Male Female

Please send completed form to:
United Way of Metropolitan Chicago Attention: Dary Mien
560 W. Lake Street, Chicago, IL 60622
Fax to 312.906.2316
For additional information regarding these or other volunteer opportunities with United Way of Metropolitan Chicago and our partner agencies, please contact Dary Mien at 312.906.2203 or dmien@uw-mc.org, or visit volunteersolutions.org/chicago.