Volunteer Application

Thank you for your interest in volunteering with Cancer Services! If you have any questions give us a call at 989-835-4841 or email info@cancerservicesmidland.org.

Your Contact Information

First Name *

Last Name *

Email *

Address Line 1 *

Address Line 2

Phone

City *

State *

State/Province

Zip *

Postal Code

Country / Region

Emergency Contact

Emergency Contact Phone

Emergency Contact Email

Basic Information

Birth Date (MM/DD/YYYY) * The date field Birth Date (MM/DD/YYYY) is required.

Cell phone number * The phone field Cell phone number is required.

Do you have other time commitments? * The field Do you have other time commitments? is required.

If yes, please explain The maximum length for the field If yes, please explain is 500 characters.

Prior volunteer experience * The field Prior volunteer experience is required.

Talents, Skills, Hobbies and Interests

Tell us a little more about you

Have you personally battled cancer? * The field Have you personally battled cancer? is required.

If yes, please describe your journey The maximum length for the field If yes, please describe your journey is 5000 characters.

Have you experienced loss of a loved one recently?

If yes, specify relationship and when they passed The maximum length for the field If yes, specify relationship and when they passed is 500 characters.

List any other language(s) you speak The maximum length for the field List any other language(s) you speak is 500 characters.

Is there anything else you'd like us to know? The maximum length for the field Is there anything else you'd like us to know? is 5000 characters.

Tell us why you want to volunteer for us

Why us? * The field Why us? is required.

How did you hear about us? * The field How did you hear about us? is required.

Is there a specific program you are interested in?

References

Please list at least one reference.

Reference first and last name * The field Reference first and last name is required.

Reference relationship * The field Reference relationship is required.

Reference email * The email field Reference email is required.

Reference phone * The phone field Reference phone is required.

Reference first and last name The maximum length for the field Reference first and last name is 500 characters.

Reference relationship The maximum length for the field Reference relationship is 500 characters.

Reference email The field Reference email must be an email.

Reference phone The field Reference phone must be a phone number.

Consent

Criminal Background Check

By choosing 'yes' to a criminal background check, you are consenting to Cancer Services performing a basic criminal background check on yourself. Your consent shows that you understand this will help to ensure your safety, as well as the safety of those who you may be serving.

Marketing Release

By choosing 'yes' you hereby authorize Cancer Services to publish photographs and videos taken of you and statements you have made including your name and likeness for use in print, online, broadcast, and video-based marketing materials, as well as for other Cancer Services publications.

You further acknowledge that participation is voluntary and that you will not receive financial compensation of any kind associated with the taking or publication of these photos, videos, or statements. Publication of these materials does not confer any right of ownership or royalties. You hereby release Cancer Services, its clients, contractors or any third party involved from liability for any claims by you or any third party in connection with your participation.

Criminal Background Check * The field Criminal Background Check is required.

Marketing Release * The field Marketing Release is required.