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Volunteer Application

Personal Information

Name:

City: State: Zip:

Male Female

Background (Must be at least 17 to volunteer)

Month: Day: Year:

Social Security Number (Required):

ID/Driver's License Number:

Contact Information

Home: Work: Cell:

E-Mail:

Areas of Interest

General

Tutoring

Administration

Recreation

Mentoring (Approval Required)

Intership (Approval Required)

Are you in college? Yes No

Name of College/University?

Anticipated Date of Graduation?

Are you applying for work study?

Medical and Background Information

Do you have any physical limitation? Yes No

If yes, what?

Are you on any medication? Yes No

If yes, what?

Have you ever used any illegal substance? Yes No

If yes, what?

Have you ever been convicted of a felony? Yes No

If yes, please explain?

Please initial below. This acknowledges that prior to being allowed to tutor and/or volunteer at the Reichert House Youth Academy, that a criminal background check will be performed by the Gainesville Police Department, they acknowledge that all information given above is true and accurate.

Initials


Contact Info

Phone: (352) 334.2320
Address:
1704 S.E. Second Ave.
Gainesville, FL 32641
E-mail: info@reicherthouse.org

Enroll Your Son

Each year, the Reichert House provides educational services to more than 130-young men in Gainesville. Our relationship with the city, local police and school board, is helping the academy reach its mission of uplifting the lives of the young men throughout town.

If you are interested in having your son join the academy, please click here for more information.

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