2. 
3. Name*
5. Street Address*
7. City*
8. State*
9. Zip*
11. Home Phone*
12. Cell Phone
14. Email*
15. Borough or Township of Residence*
17. DOB*
    DOB
18. SSN*
19. Driver's License Number*
21. Employer*
22. Occupation*
23. How long?*
25. Education*
26. College
27. Degree
29. Describe any previous volunteer experience
31. Name of organizations in which you belong (church, social, civic, etc)
33. Reason for volunteering
35. List 3 References:
37. Name*
38. Address*
39. Phone*
41. Name*
42. Address*
43. Phone*
45. Name*
46. Address*
47. Phone*
49. Note:
    I certify that the answers given herein are true and complete to the best of my knowledge. I authorize the investigation of all statements contained in this application for volunteer services as may be necessary for arriving at an acceptance decision. I agree to allow the County of Westmoreland, its managers and/or authorized personnel, to contact any references I have listed on my volunteer application. I also agree to submit to a Criminal Background Check, Child Abuse Clearance & FBI Criminal History check. I understand if accepted into the program, I will abide by all rules and regulations of the County of Westmoreland County Youth Commission Program.
51. Signature of Applicant*
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field