Specialized Needs Recreation

SNR VOLUNTEER APPLICATION

Name: ________________________________  Date of Birth:  ________________  Date:_____________

Residence Address:                                                                                                                         

                                                                           (Street)

                                                                     (City/State/Zip)

Years at Current Residence:                                   In Kootenai County:                                          

Home Phone (___)                                                Business Phone (___)                                        

Mobile:                                                                  FAX:                                                                  

Brief explanation on why you would like to volunteer for SNR.________________________________

___________________________________________________________________________________

Area(s) of Expertise:                                                                                                                        

Education (Circle Highest Grade/Degree Completed)

Middle School          High School          AA             BA/BS          MA/MS           Ph.D.

Please list other certifications, awards, etc.:                                                                                     

Committees/Commissions/Boards currently serving on:                                                                  

Past Committees/Commissions/Boards served on:                                                                           

Comments:                                                                                                                                      

Please list any other community organization involvement:                                                             

Have you ever been convicted of a crime?  Yes    No     (If yes, please explain below)

____________________________________________________________________________________

Signature                                                                                              Date

Please return to:    Angie Goucher                        P.O. Box 2451 Coeur d’Alene Idaho 83816

                              PHONE (208) 755-6781            FAX (208) 769-2284

A background check is required although SNR will be responsible for this cost.