Volunteer Application

General Information

First
Last
Middle Initial
(MM/DD/YYYY)
(MM/DD/YYYY)

Education

(Please note that at least one row of Education information is required.)
High School, University and other  institutions attended.  
Begin with most recent. 
Discipline, Program or Major Degree/Diploma/
Certificate
Date Obtained or 
Expected
(MM/DD/YYYY) 

Qualifications

Extracurricular Activities

References

Volunteer Interests

Please check ALL areas in which you have a potential interest in volunteering as an assistant or a facilitator

The Center for Individuals with Physical Challenges provides an equal opportunity Volunteer Program. We adhere to a policy of selecting Volunteers without regard to race, color, religion, gender, age, marital status, sexual orientation, national origin, political affiliation or disability. Opportunity to Volunteer with The Center depends solely upon an applicant's qualifications.

The Center for Individuals with Physical Challenges
Attn: Volunteer Program
815 South Utica Avenue
Tulsa, OK 74104

Ph: 918-584-8607 Fax: 918-584-8646
www.tulsacenter.org