Firstname:*        Lastname:*   

Address:*     

City:*         

Province:*      

Postal Code:*      

Telephone:*      

E-Mail:*      

Please enter the Job title and reference number ( if there is any )

Job Title:      Reference no:

Check the days & times which you will be available for volunteer work:

Mon       From:        To: 

Tue       From:        To: 

Wed       From:        To: 

Thu       From:        To: 

Fri       From:        To: 

Sat       From:        To: 

What are your interests? ( Check all that apply )

Sports ( Please Specify ):   

Music    Gardening     Photography

Art ( Please Specify ):  

Cinema    Theater     Philosophy

Literature    Other ( Please Specify ):     

Why do you want to volunteer with Dixie Bloor?

I want to help others      To gain new experience

Requirement for school   To gain experience in order to find a job

Other reason ( s ):  

What is your educational background?

Primary: Grade      Secondary: Grade  

College: Course Name:  

Graduated:Yes   No

University Major: 

Graduated:Yes   No

Are you willing to undergo some traning prior to your volunteer work?

Yes   No

How did you learn about our agency?

Friend   I live in the area    Sign   Other Agency DBNC Staff   I am a member    I am / was a program user

What language ( s ) do you speak/write?

Language(s) spoken: 1   2   3 

Language(s) written: 1   2   3 

The following services are currently offered by this agency.
Which area would you be interested in being involved with? ( Check all that apply to you )

Child Care   Immigrant Settlement    Parent Network

Family Drop-In   Multicultural Family Resource    Seniors Programs

IT Dept     Youth ( Must be a youth to be involved )

Language instruction for Newcomers   Office Administration

Mentoring   Reception   Language Interpreter

Special Events   Tax Preparation

Other:  

Which of the following areas would be of interest to you?

Children    Adults    Seniors   Speaking to groups

Computer Work    Office Work    Cleaning/Maintenance

Other:  

Do you have previous volunteer experience?
If Yes, then please specify the organization and the position held.

1)  2) 

What are the special skills that you would like to offer at this Agency?

a)  b)  c) 

Additional Comments: 


   

Manager, Community Development
Dixie Bloor Neighbourhood Center
1420 Burnhamthorpe Rd.East,Mississauge, ON LAX 2Z9
Fax:(905) 629-0791 Email: hazelh@dixiebloor.ca