Double Up Food Bucks Volunteer Application

Name

Contact Information

Name (First + Last) *

Home Address

Email Address *

Phone Number *

Date of Birth *

Interest and Experience

Have you volunteered before? If so, what did you do? *

What experiences have you gained that could apply in your volunteer work with Double Up Food Bucks? *

Why do you want to be a Double Up Food Bucks Volunteer? *

How did you hear about us? *

More About You

The questions in this section are for learning more about volunteers and matching them with the role that best fits their skills, abilities, and interests. It is not required to answer “yes” to any of the questions or to have any of the skills below.

For more detailed information about the volunteer role, visit www.Iowahealthieststate.com/double-up-food-bucks/get-involved or contact the Iowa Healthiest State Initiative at info@iowahealthieststate.com

Are you able to stand for 2 hours with breaks? *

Do you have reliable transportation? *

Have you ever used Double Up Food Bucks? *

What is your T-shirt size? *

Small
Medium
Large
X-Large
XX-Large
Other

Other T-shirt size:

In which area are you interested in volunteering? (Check all that apply.) *

What is the earliest date you can begin volunteering? *

How often can you volunteer? *

Agreement and Electronic Signature

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

By typing my first and last name in the box below, I affirm that I am signing this Agreement electronically. I agree that my electronic signature is the legal equivalent of my manual signature on this Agreement.

Signature *

Date *

Contact Information

Interest and Experience

More About You

Agreement and Electronic Signature

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