Name:*
Address:
Phone:*
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E-mail:*
Date of Birth:*
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List any previous or current volunteer/work experience you have with non-profit organizations including dates, type of organization, and your position.*
What is your experience working with youth and in particular queer youth or at-risk youth?*
Please tell us what you feel are the most important issues facing queer youth today--in the Rogue valley and beyond.*
How did you find out about LRP? An individual? One of the programs? Media?*
Why do you want to serve as a volunteer for LRP?*
Do you have a criminal record? If so, please explain.*

References: Please include both personal and professional references.

Reference 1 Name:*
Reference 1 Phone:*
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Reference 1 Relation:*

Reference 2 Name:*
Reference 2 Phone:*
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Reference 2 Relation:*

Reference 3 Name:*
Reference 3 Phone:*
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Reference 3 Relation:*

Please check all areas in which you are interested or qualified to help us:
Other/Additional Comments:
I am human: