Autism Society of Greater Akron

It is ASGA's policy to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

First Name(*)

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Last Name(*)

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Street Address(*)

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City(*)

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State(*)

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Zip(*)

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Email Address(*)

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Confirm Email(*)

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Phone(*)

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Best way to contact you:(*)

Text Phone Call Email

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Please describe why you are interested in volunteering with the Autism Society.(*)

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Please explain your connection to or experience with individuals with disabilities. (Not a requirement to volunteer)(*)

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Share the special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports. List any specific ways you feel ASGA could benefit from your help. (*)

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Are you a student?(*)

YesNo

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If so, where?

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College student? What are you studying?

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Date of Birth(*)

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Have you ever been convicted of a crime?(*)

YesNo

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If yes, please provide nature of crime.

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Employment Status?(*)

Full TimePart TimeNot Employed

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Name of Employer

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As an ASGA volunteer, I hereby give the Autism Society of Greater Akron (ASGA) permission to publish photographs or video of me in any promotional material without incurring any liability to ASGA or any photographer/videographer hired on behalf of ASGA. The materials may include, but are not limited to, newsletters, annual reports, brochures, advertisements, websites, social media sites, training materials, and/or posters.

The information I have provided to ASGA is 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.

I agree to the above statements by checking this box

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Thank you for your interest in the Autism Society of Greater Akron! We look forward to getting to know you!

(*)

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JA Beranis

Volunteer Application