Volunteer Now

Tech Connect

Personal Information

First Name

Last Name

Home Address

City

State

Zip

Email Address

Phone Number

Date of Birth (MM/DD/YYYY)

Preferred Name/Nickname (if any)

Emergency Contact

Name

Relationship to You

Phone Number

School / College / Organization (if applicable)

Institute Name

Current Grade or Year

Advisor/Teacher Contact (optional)

Availability

How many hours per week can you volunteer?

2-4 hrs/week 5-8 hrs/week 9-12 hrs/week Flexible

Areas of Interest (check all that apply)

Helping seniors with technology (smartphones, tablets, computers) Attending health education events Survey distribution and collection Video creation / social media Photography / interviews Event setup and support Administrative support Podcast production assistance

Questions / Comments

I confirm that the information provided is true and accurate.

I understand I am volunteering with Simple Choice Tech Connect and agree to attend orientation and follow all program guide.

Date

Parent/Guardian Name (if under 18)

Parent/Guardian Phone/Email

Date